Continuation Of Contraceptive Use Research Articles

The Impact of COVID-19 Outbreak on Family Planning Services in Indonesia: Evidence from National Routine Statistics

At the beginning of the pandemic, the policy focused on COVID-19 prevention and control. Health facilities faced disruption temporarily regarding contraceptive services. This study analysed the impacts of the COVID-19 outbreak on Family Planning services in Indonesia. Monthly routine statistics from the National Population and Family Planning Board contraceptive service were examined to determine the trends in contraceptive services in Indonesia before and during the COVID-19 Pandemic from January to December 2020. The study was secondary data analysis by utilizing monthly report data from all provinces in Indonesia. Comparison data would account for the monthly trends before and during the pandemic. There was a decrease in contraceptive services between March and April 2020. However, the trend started to increase in June when a one million acceptors campaign was conducted to provide free family planning services in 34 provinces. Injectable (54%) and pills (39%) remain the most favorable contraceptives during the pandemic. IUDs and implants peaked in June 2020 (288,503 users) and September 2020 (214,061 users). The massive campaign of contraceptive services has had a positive impact in increasing the contraceptive users. Contraceptive services are conducted following strict health protocols. Continuation of contraceptive use among reproductive couples still needs to be increased.

Modern contraceptives use and associated factors among perimenopausal women in Ethiopia

Introduction: many women think they can stop using contraceptives once they are in their 40s, as they are aware that their fertility declines. Nevertheless, women do still get pregnant in their late 40s and even into their 50s, which necessities the continuation of contraceptive use if pregnancy is to be avoided. However, no study has evaluated the magnitude and factors associated with contraceptive use of perimenopausal women in Ethiopia. Thus, this study aimed to estimate the prevalence of contraceptive use and associated factors among perimenopausal women in Ethiopia.

Self-administered subcutaneous medroxyprogesterone acetate for improving contraceptive outcomes: a systematic review and meta-analysis

BackgroundSubcutaneous depot medroxyprogesterone acetate is an easy-to-use injectable contraceptive. A trained person can administer it, including women through self-injection. The objective of this systematic review and meta-analysis was to assess the effectiveness and safety of self-injection versus provider-administered subcutaneous depot medroxyprogesterone acetate for improving continuation of contraceptive use.MethodsWe searched for randomized controlled trials on November 1, 2020 in Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, Embase, Web of Science, Scopus, Open Grey, clinical trials registries, and reference lists of relevant studies. We did not impose any search restrictions. We included randomized trials comparing self- versus provider-administered subcutaneous depot medroxyprogesterone acetate. Two authors independently screened trials, extracted data, and assessed the risk of bias in the included studies. We used risk ratio and 95% confidence intervals for dichotomous outcomes.ResultsWe identified 3 randomized trials (9 reports; 1264 participants). The risk of bias in the included studies was low except for performance bias and detection bias of participant-reported outcomes in unmasked trials. Self-administration, compared to provider-administration, increased continuation of contraceptive use (risk ratio 1.35; 95% confidence intervals 1.10–1.66); moderate-certainty evidence). Self-injection appears to be making more of an impact on continuation for younger women compared to women 25 years and older and on women living in low and middle income compared to high income countries. There was no subgroup difference by the type of care provider (community health worker vs. clinic-based provider).ConclusionsSelf-injection of subcutaneous depot medroxyprogesterone acetate probably improves continuation of contraceptive use. The effects on other outcomes remain uncertain because of the very low certainty of evidence.

Patterns and determinants of modern contraceptive discontinuation among women of reproductive age: Analysis of Kenya Demographic Health Surveys, 2003-2014.

This study aimed to examine patterns and determinants of modern contraceptive discontinuation among women in Kenya. Secondary analysis was conducted using national representative Kenya Demographic and Health Surveys of 2003, 2008/9, and 2014. These household cross-sectional surveys targeted women of reproductive age from 15 to 49 years who had experienced an episode of modern contraceptive use within five years preceding the surveys from 2003 (n = 2686), 2008/9 (n = 2992), and 2014 (5919). The contraceptive discontinuation rate was defined as the number of episodes discontinued divided by the total number of episodes. Weighted descriptive statistics, multivariable logistic regression analysis, and Cox proportional hazards analysis were used to examine the determinants of contraceptive discontinuation. The 12-month contraceptive discontinuation rate for all methods declined from 37.5% in 2003 and 36.7% in 2008/9 to 30.5% in 2014. Consistently across the three surveys, intrauterine devices had the lowest 12-month discontinuation rate (6.4% in 2014) followed by implants (8.0%, in 2014). In 2014, higher rates were seen for pills (44.9%) and male condoms (42.9%). The determinants of contraceptive discontinuation among women of reproductive age in the 2003 survey included users of short-term contraception methods, specifically for those who used male condoms (hazard ratio [HR] = 3.30, 95% confidence interval [CI] = 2.13-5.11) and pills (HR = 2.68; 95CI = 1.79-4.00); and younger women aged 15-19 year (HR = 2.07; 95% CI = 1.49-2.87) and 20-24 years (HR = 1.94; 95% CI = 1.61-2.35). The trends in the most common reasons for discontinuation from 2003 to 2014 revealed an increase among those reporting side effects (p = 0.0002) and those wanting a more effective method (p<0.0001). A decrease was noted among those indicating method failure (p<0.0001) and husband disapproval (p<0.0001). Family planning programs should focus on improving service quality to strengthen the continuation of contraceptive use among those in need. Women should be informed about potential side effects and reassured on health concerns, including being provided options for method switching. The health system should avail a wider range of contraceptive methods and ensure a constant supply of commodities for women to choose from. Short-term contraceptive method users and younger women may need greater support for continued use.

Share of current unmet need for modern contraceptive methods attributed to past users of these methods in India.

Despite persistent efforts, unmet need for contraceptives in India has declined only slightly from 14% to 13% between 2005-06 and 2015-16. Many women using a family planning method discontinue it without switching to another method and continue to have unmet need. This study quantified the share of current unmet need for modern contraceptive methods attributed to past users of these methods in India. Data were drawn from two rounds of the National Family Health Survey conducted in 2005-06 and 2015-16. Using information on women with current unmet need, and whether they used any modern method in the past, the share of past users with current unmet need for modern methods was calculated. Bivariate and multivariate analyses were performed. Among 46 million women with unmet need, 11 million were past users of modern methods in 2015-16. The share of current unmet need attributed to past users of modern contraceptive methods declined from 27% in 2005-06 to 24% in 2015-16. Share of current unmet need attributed to past users was associated with reversible method use. This share rose with increased use of modern reversible methods. With the Indian family planning programme's focus on increasing modern reversible method use, the share of unmet need attributed to past users of modern methods is likely to increase in the future. The programme's emphasis on continuation of contraceptive use, along with bringing in new users, could be one of the key strategies for India to achieve the FP2020 goals.

Side effect concerns and their impact on women\u2019s uptake of modern family planning methods in rural Ghana: a mixed methods study

BackgroundDespite availability of modern contraceptive methods and documented unmet need for family planning in Ghana, many women still report forgoing modern contraceptive use due to anticipated side effects. The goal of this study was to examine the use of modern family planning, in particular hormonal methods, in one district in rural Ghana, and to understand the role that side effects play in women’s decisions to start or continue use.MethodsThis exploratory mixed-methods study included 281 surveys and 33 in-depth interviews of women 18–49 years old in the Amansie West District of Ghana between May and July 2018. The survey assessed contraceptive use and potential predictors of use. In-depth interviews examined the context around uptake and continuation of contraceptive use, with a particular focus on the role of perceived and experienced side effects.ResultsThe prevalence of unmet need for modern family planning among sexually active women who wanted to avoid pregnancy (n = 135) was 68.9%. No factors were found to be significantly different in comparing those with a met need and unmet for modern family planning. Qualitative interviews revealed significant concerns about side effects stemming from previous method experiences and/or rumors regarding short-term impacts and perceived long-term consequences of family planning use. Side effects mentioned include menstrual changes (heavier bleeding, amenorrhea or oligomenorrhea), infertility and childbirth complications.ConclusionAs programs have improved women’s ability to access modern family planning, it is paramount to address patient-level barriers to uptake, in particular information about side effects and misconceptions about long-term use. Unintended pregnancies can be reduced through comprehensive counseling about contraceptive options including accurate information about side effects, and the development of new contraceptive technologies that meet women’s needs in low-income countries.

Immediate versus delayed postpartum insertion of contraceptive implant for contraception.

The spacing of pregnancies has a positive impact on maternal and newborn health. The progestin contraceptive implant, which is a long-acting, reversible method of contraception, has a well-established low failure rate that is compatible with tubal sterilization. The standard provision of contraceptive methods on the first postpartum visit may put some women at risk of unintended pregnancy, either due to loss to follow-up or having sexual intercourse prior to receiving contraception. Therefore, the immediate administration of contraception prior to discharge from the hospital that has high efficacy may improve contraceptive prevalence and prevent unintended pregnancy. To compare the initiation rate, effectiveness, and side effects of immediate versus delayed postpartum insertion of implant for contraception. We searched for eligible studies up to 28 October 2016 in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and POPLINE. We examined review articles and contacted investigators. We also checked registers of ongoing clinical trials, citation lists of included studies, key textbooks, grey literature, and previous systematic reviews for potentially relevant studies. We sought randomised controlled trials (RCTs) that compared immediate postpartum versus delayed insertion of contraceptive implant for contraception. Two review authors (JS, YW) independently screened titles and abstracts of the search results, and assessed the full-text articles of potentially relevant studies for inclusion. They extracted data from the included studies, assessed risk of bias, compared results, and resolved disagreements by consulting a third review author (PL or SK). We contacted investigators for additional data, where possible. We computed the Mantel-Haenszel risk ratio (RR) with 95% confidence interval (CI) for binary outcomes and the mean difference (MD) with 95% CI for continuous variables. Three studies that included 410 participants met the inclusion criteria of the review. We did not identify any ongoing trials. Two included studies were at low risk of selection, attrition, and reporting biases, but were at high risk of performance and detection biases due to the inability to blind participants to the intervention. One included study was at high risk of attrition bias. The overall quality of the evidence for each comparison ranged from very low to moderate; the main limitations were risk of bias and imprecision.Initiation rate of contraceptive implants at the first postpartum check-up visit was significantly higher in the immediate insertion group than in the delayed insertion group (RR 1.41, 95% CI 1.28 to 1.55; three studies, 410 participants; moderate quality evidence).There appeared to be little or no difference between the groups in the continuation rate of contraceptive implant used at six months after insertion (RR 1.02, 95% CI 0.93 to 1.11; two studies, 125 participants; low quality evidence) or at 12 months after insertion (RR 1.04; 95% CI 0.81 to 1.34; one study, 64 participants;very low quality evidence)Women who received an immediate postpartum contraceptive implant insertion had a higher mean number of days of abnormal vaginal bleeding within six weeks postpartum (MD 5.80 days, 95% CI 3.79 to 7.81; one study, 215 participants; low quality evidence) and a higher rate of other side effects in the first six weeks after birth (RR 2.06, 95% CI 1.38 to 3.06; one study, 215 participants; low quality evidence) than those who received a delayed postpartum insertion. There appeared to be little or no difference between the groups in heavy, irregular vaginal bleeding or associated severe cramping within 12 months (RR 1.01, 95% CI 0.72 to 1.44, one study, 64 participants;very low quality evidence).It was unclear whether there was any difference between the groups in scores for participant satisfaction on a 0-10 scale (MD -0.40, 95% CI -1.26 to 0.46, low quality evidence), or in rates of unintended pregnancy (RR 1.82, 95% CI 0.38 to 8.71, 1 RCT, 64 women, very low quality evidence) at 12 months, or in rate of breastfeeding rate at six months (RR 2.01, 95% CI 0.72 ro 5.63, 1 RCT, 64 women, very low quality evidence) rate did not differ significantly between the groups. Evidence from this review indicates that the rate of initiation of contraceptive implant at the first postpartum check-up visit was higher with immediate postpartum insertion than with delayed insertion. There appeared to be little or no difference between the groups in the continuation rate of contraceptive implant use at 6 months. It was unclear whether there was any difference between the groups in continuation of contraceptive use at 12 months or in the unintended pregnancy rate at 12 months.

Reducing unmet need and unwanted childbearing: evidence from a panel survey in Pakistan.

Pakistan's high unmet need for contraception and low contraceptive prevalence remain a challenge, especially in light of the country's expected contribution to the FP2020 goal of expanding family planning services to an additional 120 million women with unmet need. Analysis of panel data from 14 Pakistani districts suggests that efforts to reduce unmet need should also focus on empowering women who are currently practicing contraception to achieve their own reproductive intentions through continuation of contraceptive use of any method. Providing women with better quality of care and encouraging method switching would bridge the gap that exists when women are between methods and thus would reduce unwanted births. This finding is generalizable to other countries that, like Pakistan, are highly dependent on short-acting modern and traditional methods. The approach of preventing attrition among current contraceptive users would be at least as effective as persuading nonusers to adopt a method for the first time.

A comparison of pregnancy prevention programmes in Europe

Background: Pregnancy prevention programmes (PPP) can be imposed by regulatory authorities to minimise the risk of exposure to teratogenic drugs during pregnancy, thus preventing congenital anomalies. The objective of this study was to explore the reasons to request PPPs in the EU and the elements that they included.Methods: For the seven drugs with a PPP, the Summary of Product Characteristics (SmPC) and publicly available assessment reports at the EMA website were used to obtain data.Results: Five of the seven drugs obtained a PPP based on an established or expected high teratogenic risk in humans. Similarities in the PPPs were: pregnancy tests both before and monthly during drug use; contraceptive use and pregnancy prevention counselling. Differences regarded educational materials, restricted drug supply, continuation of contraceptive use and pregnancy tests after treatment. The last two differences could be explained by pharmacological characteristics of the drug.Conclusions: The reason for requesting a PPP is not always clearly defined and variation in risk minimisation measures for teratogenic drugs exists. There is a need for regulatory guidance on proper judgement to request for a PPP and its development. Knowledge on the benefits and burden of PPPs in clinical practice is necessary to optimise PPPs.

Barriers to Modern Contraceptive Practices among Selected Married Women in a Public University in Malaysia

In Malaysia, only 30% of the married women use modern contraceptive methods. Low usage of contraceptive methods, results in high rates of unwanted pregnancies and its consequence which includes; psychological problems physical health and unsafe abortion. The main purpose of this study is to understand the barriers of modern contraceptive practices among women in University Putra Malaysia. This study was carried out through two main research questions: 1.What is the women’s perceptions of modern contraceptive methods? 2. Why women do not use modern contraceptive methods? A qualitative research method was used for exploring misconceptions and barriers to contraceptive use among married female staff in University Putra Malaysia (UPM). The data was collected using the non probability, purposive sampling method, from 6 women by face to face interviews, which was also audio-recorded. The records were then transcribed verbatim and analyzed consecutively. This study finding showed there were personal, cultural, and health system barriers to modern contraceptive use. The women have been surrounded by fears, and misconceptions which serve as obstacles to initiation and continuation of contraceptive use. Strong socio-cultural norms and health services barriers including negative response of service providers, and low male family planning activities influence contraceptive use negatively. This study suggests that the promotion of modern contraceptive methods should be considered in women and men educational programs. Further studies should examine health providers’ views and quality of family planning services.

Contraceptive Discontinuation and Switching Patterns in Bangladesh

Contraceptive discontinuation and switching behaviour of a couple has significant influence on fertility in Bangladesh in spite of a successful national family planning programme. This study examines the determinants of contraceptive use, discontinuation and switching behaviour by using calendar data extracted from 2004 Bangladesh Demographic and Health Survey. Life table and multiple-decrement life table techniques are used to find out the contraceptive discontinuation rates and method specific discontinuation rates. The study shows that contraceptive prevalence increases with education, socioeconomic status, intention status, residence, age, parity and whether a family planning worker visited the home. Almost half of women who initiate the use of a method discontinue use within a year and nearly two-thirds discontinue within two years. The IUD has the lowest discontinuation rates, whereas the condom, followed by the injectable and oral contraceptive pill, have the highest rates. The findings indicate that side effects are the major cause of discontinuation for the pill, IUD and injectables. Determinants of switching behaviour are analyzed to identify users in need of contraception as well as those who abandoned use and would like to continue using contraception. Findings encompass the whole process of contraceptive use as well as women’s experience and difficulties in continuation of contraceptive use. Kaushalendra KUMAR SINGH, Professor, Department of Statistic, Banaras Hindu University, Varanasi – 221 005, India, E-mail: kksingh@bhu.ac.in . Tapan KUMAR ROY, Research Scholar, Department of Statistic, Banaras Hindu University, Varanasi – 221 005, India. E-mail: roy.tapan@gmail.com . Brijesh PRATAP SING, Assistant Professor, Faculty of Commerce, Banaras Hindu University, Varanasi – 221 005, India. E-mail: brijesh@bhu.ac.in . DOI: 10.4402/genus-157

Continuation of contraceptive use in Slovenia — life-table analysis

The effectiveness and continuation rate of contraceptives were analyzed in a survey from July 1 1984 to July 1 1989 as part of the interdisciplinary Fertility Survey Slovenia 1989. A representative sample of 469 women 15-44 years old constituted 599 contraceptive-use intervals. The data were collected retrospectively by in-depth interviews. Continuation of contraceptive use was analyzed with a standard actuarial Cutler-Ederers life-table method for 1 year. Continuation rates were established by using a single decrement life-table and gross Tietze-Potter rates were calculated. The differences between the life-tables were revised with a log-rank test. P values 0.10). Age was associated with failure of coitus-dependent methods (P = 0.094) but not with discontinuation of these methods (P > 0.10). The highest contraceptive failure rate in coitus-dependent methods occurred in the 20-24 and the lowest in the 15-19 age group.

Never-pregnant adolescents and family planning programs: contraception, continuation, and pregnancy risk.

Four hundred urban Black teenagers enrolling in a family planning program before pregnancies occurred were followed for one year to assess factors influencing continuation of contraceptive use. Over half the follow-up respondents claimed to always use contraception. Program discontinuers were less likely to use contraception, but nearly half had no sex activity when contacted at follow-up. Sex frequency reported in the sample was low. Background factors of age, grade, and household were associated with contraceptive use and with pregnancy. Girls who had pregnancies were significantly more likely to live in a single-parent household, to have sex more frequently, and to have stated at enrollment that they wanted their first child before age 20. A majority of the sample, nearly all of whom obtained oral contraception, did not know at the one year follow-up how to use any alternative methods for preventing conception, hence many would again be at risk of pregnancy when sex activity resumed.