Long-acting And Permanent Methods Research Articles

Factors of Using Long Acting and Permanent Methods (LAPM) of Contraception: Bangladesh Perspective

The Government of Bangladesh is very much aware of controlling excessive birth rate to maintain population problem. Though Bangladesh is owning self-sufficiency in many sectors, the increasing population is a great impediment for the development of the country. So, promoting different contraceptive methods is of much importance. This work aims at identifying the important determinants that affect the long-acting and permanent methods (LAPM) of contraception. Firstly, chi-square test of association is carried out for defining the correlates of LAPM of contraception using Bangladesh Demographic and Health Survey (BDHS), 2017-18 data. For estimating the effects of each controlled independent variables, data are further analyzed within a multivariate framework. To obtain consistent and efficient estimates of parameters of interest, multinomial logistic regression model is used in this work. The study finds several socio-economic and demographic variables having high impact on using LAPM. The study findings are properly discussed and recommendations are made accordingly for the policy makers.
 Dhaka Univ. J. Sci. 71(2): 87-94, 2023 (July)

Women's intention to use long acting and permanent contraceptive methods and associated factors among family planning users in Addis Ababa, Ethiopia: A Cross sectional study.

The main objective of the study was to assess the magnitude of women's intention to use long-acting and permanent contraceptive methods and associated factors among short term family planning users in Addis Ababa public health centers, Ethiopia, 2020. A Facility-based cross-sectional study design was implemented in Addis Ababa public health center and data was collected using a pretested structured questionnaire on 504 participants, which was selected by multistage cluster sampling methods among family planning users in selected public health centers from March to April 2020. Collected data were coded and entered into EPI INFO version 4.6.0.0 and exported to SPSS version 25.0 for analysis. Multivariate logistic regression model was used to determine independent predictors at a 95% confidence interval and p <0.05 was considered significant. This study found the prevalence of contraception intention to use long acting and permanent methods (LAPMs) among participants were 60%. Predictors of LAPM desired number of children (AOR: 14.55, 95%CI (3.29-6.42), respondent's education (AOR: 0.36, 95%CI (0.20-0.64) and participant's occupation status (AOR: 8.75, 95% C I (1.31-5.84) were significantly associated with contraception intention.

The National Composite Index for Family Planning (NCIFP): Results and Methodological Issues.

Background: The " FP2020 Global Partnership" signaled a shift to broader, rights-based approaches to family planning programs, and the National Composite Index for Family Planning was developed as part of related measurement efforts. Methods: In each country 10-15 experts on the family planning program completed a 35-item questionnaire, first in 2014 in 89 countries, and in 2017 in 84 countries. Data were entered in Excel, with checks for consistency and data quality. The total score, and scores for each of 5 dimensions of effort are averages across the 35 indicators. Analytic techniques included cross-tabulations, graphical and correlation approaches. Results: The average total score for all countries in 2017 was 64 of the maximum of 100 of effort. Sub-regions differed: Anglophone and Francophone sub-Saharan Africa (SSA) scored highest in the total score and across all 5 dimensions. Next in order came Latin America and the Caribbean, Asia, the Middle East and North Africa, and Eastern Europe and Central Asia. Despite large differences in scores, the sub-regions followed similar profiles across the 35 indicators. The long term rise in the basic family planning effort scores continued, extending the series from surveys approximately every five years beginning in the 1980s. The highest score reached was for the strategy dimension, but the others were close.Their relative levels remained essentially the same as in the 2014 survey. NCIFP scores correlated positively with modern contraceptive use in both the sub-Saharan Africa (SSA) and non-sub-Saharan Africa (non-SSA) countries, but the relationships were stronger for SSA. Access to long-acting and permanent methods (LAPMs) was accompanied by greater LAPM use and modern method use. Conclusion: Repeated surveys in most developing countries show improvements in family planning effort, though unevenly, by 35 indicators and across regions.

Association between empowerment factors and the utilization of long-acting and permanent contraceptive methods among married women in Indonesia

Background and purpose: The use of long-acting and permanent methods (LAPMs) of contraception becomes one of the government’s efforts to ensure the continuity of family planning program. Factors associated with the LAPMs use can be contingent upon the study context or setting that includes socio-demographic, social and cultural norms, and women empowerment factors. This study aims to examine the associations between women empowerment and the LAPMs use.Methods: This was a cross-sectional study involving 97,316 records of married women aged 15-49 years, retrieved from three rounds of the Indonesia Demographic and Health Survey/IDHS (2007, 2012, and 2017). The dependent variable is the LAPMs use, whereas the main independent variables were women empowerment factors (i.e., educational level, occupational status, participation in household decision-making, attitude toward wife-beating). Adjusted associations between women empowerment and the LAMPs use were examined using binary logistic regression by controlling the influence of socio-demographic variables as potential confounders.Results: About half of women in this study were 35-49 years old and completed primary education. Education level was found to be positively associated with the use of LAPMs. Working women increased the likelihood of using LAPMs by 1.10 (95%CI: 1.03-1.17) times. In addition, those who approved for being beaten by their husband in any circumstance were less likely to use LAPMs (OR=0.91; 95%CI: 0.86-0.97). However, participation in household decision-making was not associated with the LAMPs use.Conclusion: Women empowerment factors that included educational level, occupational status, and the attitude toward wife-beating were associated with the use of LAPMs among Indonesian married women. Therefore, improving women empowerment by increasing women’s educational level, participation in labor force, and reducing women’s vulnerability to domestic violence can increase the uptake of LAPMs.

Changes in Rates of Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the USA, 2012-2016.

To examine recent rates of long-acting and permanent methods (LAPM) of contraception use during delivery hospitalization and correlates of their use. A retrospective cohort study utilizing the 2012-2016 National Inpatient Sample of hospitalizations in the United States of America. The International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes were used to identify deliveries, inpatient long-acting reversible contraception (IPP LARC), and postpartum tubal ligation (PPTL). We conducted univariable and multivariable logistic regression to examine associations between demographic, clinical, hospital and geographical characteristics with likelihood of LAPM including IPP LARC and PPTL. Our sample included 3,642,328 unweighted deliveries. The rate of IPP LARC increased from 34.6 to 54.9 per 10,000 deliveries (58.7%), while the rate of PPTL utilization decreased from 719.5 to 671.8 per 10,000 deliveries (6.6%) over the study period. In multivariable analysis of LAPM utilization versus neither, cesarean delivery (aOR 7.25, 95% CI 7.08-7.43) was associated with greater utilization. Native American (aOR 4.01, 95% CI 2.91-5.53) race was associated with increased use of IPP LARC compared to a non-long-acting method of contraception. Age between 18 and 29 years (aOR 6.21, 95% CI 5.42-7.11) was associated with greater use of IPP LARC versus PPTL. Delivering in a rural hospital ((aOR 0.09, 95% CI 0.06-0.12) and cesarean delivery (aOR 0.09, 95% CI 0.06-0.12) were associated with greater use PPTL versus IPP LARC. The IPP LARC rate remains at less than 10% the PPTL rates in our study timeframe. The demonstrated variation in uptake of highly effective methods of contraception inpatient after delivery offer possible opportunities for better understanding and improvement in access.

528 Use of highly effective postpartum contraception by women with opioid use disorder

Rates of inpatient provision (IPP) of long acting and permanent methods (LAPM) in women with opioid use disorder (OUD) remain largely unknown. Thus, we sought to determine the rates and associated clinical and demographic factors of IPP LAPM in women with OUD. This was a retrospective cross-sectional study using the National Inpatient Sample of women with OUD who had a delivery related hospitalization between 2012 and 2016 identified using the relevant Diagnosis Related Group and ICD-9 and ICD-10 codes. Women with OUD who underwent tubal sterilization (PPTL) or received a long acting reversible contraceptive (LARC) during the delivery admission were identified using relevant ICD-9 and ICD-10 codes. Those who underwent a hysterectomy were excluded. Patients were stratified into IPP LARC, PPTL, and no long-term contraception groups. Univariate and multivariable regression analyses were performed to evaluate the relationships between collected variables and LAPM utilization. Of 22,340 eligible deliveries in women with OUD, 2,291 (10.2%) women received LAPM (Table 1).The most common form of LAPM was PPTL (86.8%). In multivariable analysis of known clinical and demographic factors associated with contraceptive decision-making, cesarean section (aOR 5.21, 95% CI 4.64-5.83) was the strongest predictor of LAPM use while stillbirth (aOR 0.23, 95% CI: 0.08-0.65) was strongly associated with not utilizing LAPM (Table 2). Region of delivery and hospital location were also associated with a higher utilization of LAPM. The rate of LAPM utilization in women with OUD appears to be dependent on delivery location and route, specifically in urban academic centers and larger facilities. Efforts should be made to expand access to LAPM equitably across the country.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Determinants of Long-Acting and Permanent Methods (LAPMS) of contraception use in Jambi Province, Indonesia

The use of long-acting and permanent methods of contraception (LAPMs) by couples of reproductive age in Jambi Province is still comparatively low. Long-term contraception users were only 18.26 percent in 2018. Based on these, the objective of the study is to analyze as follows: 1) the determinants of LAPMs and non-LAPMs used by couples of reproductive age; 2) the relationship between couples of reproductive age and use of LAPMs. Data is obtained from the 2018 Performance Monitoring and Accountability of Population, Family Planning, and Family Development programs. Data were analyzed using binary logistic regression, One-way ANOVA and Chi-Square Test. The results of the analysis found that the determinants of LAPM and non-LAPM selection by couples of reproductive age are woman’s educational attainment, woman’s employment status, the difference between ideal and actual number of surviving children, the desire for more children, the knowledge of contraceptive methods, economic conditions, and urban-rural residence. Furthermore, the characteristics of couples of reproductive age significantly related to the LAPM choice include woman’s age, woman’s educational attainment, the actual number of surviving children, the difference between ideal and actual number of surviving children, the desire for more children, the knowledge of contraceptive methods, economic conditions, and urban-rural residence.

Intention to Use Long Acting and Permanent Contraceptives Methods and Associated Factors among Family Planning Clients in West Ethiopia

Background: Long acting and permanent methods (LAPMs) of family planning (FP) are essentially important to achieve health related goals, and to meet individuals and couple’s needs. Worldwide, an estimated 80 million (38.1%) of all pregnancies are unintended and 33 million of these are due to ineffective use of a contraceptives. An increase in the use of LAPMs can reduce unintended pregnancies and the incidence of abortion. But, utilization of LAPMs is very low. Yet, the level and barriers to the use of LAPMs are not well explored in the study area. Therefore, this study was to assess intention to use LAPMs and associated factors among FP clients in Nekemte Town. Methods: Health facility based cross-sectional study was conducted on randomly selected 388 subjects in March 2015. The sample subjects were selected from all health facilities providing FP services considering proportional to sample size. Data were collected using an interviewer-administered questionnaire, entered to Epi Data version 3.1 and analyzed using SPSS version 21. Multivariable logistic regression using step-wise selection method was done to identify predictors of intention to use LAPMs at P value <0.05. Qualitative data were translated, transcribed and presented in narration to supplement the quantitative study. Results: The prevalence of intention to use LAPMs was 52.2%. Intention to use LAPMs was higher among respondents who had supportive attitude (AOR: 2.1; 95% CI: 1.3, 3.4) and increases with literacy level, where it was more than two times, five times and seven times higher among those who attended primary (AOR: 2.6; 95% CI: 1.2, 5.8), secondary (AOR: 5.2; 95% CI: 2.2, 12.6) and higher education (AOR=7.6; 95% CI: 2.9-19.7) compared to noneducated ones, respectively. It was also higher among mothers who had no myths and misconception on LAPMs (AOR: 2.1; 95% CI: 1.2, 3.6) and who had not perceived IUCD and/or implants negatively (AOR: 2.0; 95% CI: 1.2, 3.5). Those mothers who did not have functional television had lower intention of using LAPMs (AOR: 0.55; 95% CI: 0.32, 0.96). Conclusion: The prevalence of intention to use LAPMs was low, presence of myths and misconception, lack of education, unfavorable attitude and lack of functional television adversely affected intention to use LAPMs. Social and behavioral change communication should address factors that hinder intention to use LAPMs.

Contraceptive availability leads to increase in use in conflict-affected Democratic Republic of the Congo: evidence from cross-sectional cluster surveys, facility assessments and service statistics

BackgroundHumanitarian assistance standards mandate specific attention to address the sexual and reproductive health (SRH) needs of conflict-affected populations. Despite these internationally recognised standards, access to SRH services is still often compromised in conflict settings. CARE in collaboration with the RAISE Initiative strengthened the Ministry of Health (MOH) to provide contraceptive services in Maniema province, Democratic Republic of the Congo. This study evaluated the effectiveness of this support for MOH health facility provision of contraception.MethodsCross-sectional surveys in 2008 (n = 607) and 2010 (n = 575) of women of reproductive age using a two-stage cluster sampling design were conducted in Kasongo health zone. Facility assessments were conducted to assess the capacity of supported government health facilities to provide contraceptive services in 2007 and 2010. Data on the numbers of clients who started a contraceptive method were also collected monthly from supported facilities for 2008–2014.ResultsCurrent use of any modern contraceptive method doubled from 3.1 to 5.9% (adjusted OR 2.03 [95%CI 1.3–3.2]). Current use of long-acting and permanent methods (LAPM) increased from 0 to 1.7% (p < .001), an increase that was no longer significant after adjustment. All current users except a few condom users reported a health facility as the source of the method. The 2010 facility assessments found that most supported facilities had the capacity to provide short-acting and long-acting methods. Service statistics indicated that the percentage of clients who accepted a long-acting method at supported facilities increased from 8% in 2008 to 83% in 2014 (p < .001).ConclusionsThis study demonstrated that contraceptive prevalence doubled between 2008 and 2010; service statistics indicate that utilization of long-acting methods continued to increase to a majority of new clients after 2010. Strengthening the health system to provide contraceptive services enabled individuals to exercise their right to prevent unintended pregnancies. These results suggest that demand for contraception, including long-acting methods, is present even in humanitarian settings, and that women will use them when they are available and of reasonable quality. It is critical that the humanitarian community ensure that such services are available to women affected by crises.

Patterns of Contraceptive Adoption, Continuation, and Switching after Delivery among Malawian Women

Women who report use of postpartum family planning may not continue their initial method or use it consistently. Understanding the patterns of method uptake, discontinuation, and switching among women after delivery is important to promote uptake and continuation of effective methods of contraception. This is a secondary analysis of 634 Malawian women enrolled into a prospective cohort study after delivery. They completed baseline surveys upon enrollment and follow-up telephone surveys 3, 6, and 12 months post-delivery. Women were included in this analysis if they had completed at least the 3- and 6-month post-delivery surveys. Descriptive statistics were used to assess contraceptive method mix and patterns of switching, whereas Pearson’s χ2 tests were used for bivariable analyses to compare characteristics of women who continued and discontinued their initial post-delivery contraceptive method. Among the 479 women included in this analysis, the use of abstinence/traditional methods decreased and the use of long-acting and permanent methods (LAPM) increased over time. Almost half (47%) discontinued the contraceptive method reported at 3-months post-delivery; women using injectables or LAPM at 3-months post-delivery were significantly more likely to continue their method than those using non-modern methods (p<0.001). Of the 216 women who switched methods, 82% switched to a more or equally effective method. The change in contraceptive method mix and high rate of contraceptive switching in the first 12 months postpartum highlights a need to assist women in accessing effective contraceptives soon after delivery.

Factors Associated with Utilization of Long Acting and Permanent Contraceptive Methods among Women of Reproductive Age Group in Jigjiga Town

Background: Contraceptive use including short acting, long acting and permanent methods positively influence the socio-economic development of a nation by allowing families to space and limit their family size to their economic capacity. Demand for Long acting and permanent methods (LAPM) of contraception as determined by utilization and unmet need for LAPMs provide reliable information for providers. Objective: To assess factors associated with utilization level of long acting contraceptive methods and associated factors among married women of reproductive age in Jigjiga town, Somali region, Eastern Ethiopia Feb.2016. Methods: A community based cross sectional study supplemented with qualitative inquiry was conducted among randomly selected married women of reproductive age in Jijiga town from Feb to March 2014. A structured and pretested, interview administered questionnaire was used to collect data which was entered to computer by using EpiData version 3.1 and exported to SPSS version 16.0. Bivariate and multivariate logistic regression was employed to determine independent predictors of long acting and permanent contraceptive utilization level and associated factors. Result: Three hundred eighty three women of reproductive age group participated in the quantitative survey making a response rate of 97.2%. The overall prevalence of long acting and permanent contraception was 34 [8.8%]. Educational level AOR=1.53; 95% CI [0.25-9.62] Occupation AOR=2.0; 95% CI [1.00-4.50] and support from husband AOR=0.09; 95% CI [0.01-0.57] were significantly associated with long acting and permanent contraceptive utilization. Conclusion: The overall prevalence of long acting and permanent contraceptive method was low. Knowledge of contraceptive and occupation of women have significant association with use of long acting and permanent contraceptive. Extensive health information should be provided for both husband and women.

Is Household Wealth Associated With Use of Long-Acting Reversible and Permanent Methods of Contraception? A Multi-Country Analysis.

As programs continue to expand access to family planning information, services, and products, it is critical that these efforts be undertaken with an equity lens, ensuring that regardless of socioeconomic status, all women and couples can use the method that meets their needs. This study explores the relationship between household wealth and the use of long-acting and permanent methods (LAPMs) versus short-acting methods of contraception among modern method users, using multivariate analyses based on Demographic Health Survey data from 30 developing countries conducted between 2006 and 2013. Overall, and controlling for relevant individual and household characteristics including age, number of living children, education, and urban/rural residence, we found that wealthier women were more likely than poorer women to use LAPMs instead of short-acting methods: 20 of the 30 countries showed a positive and statistically significant association between wealth and LAPM use. For 10 of those countries, however, LAPM use was significantly higher only for the top (1 or 2) wealthiest quintiles. Eight countries showed no broad pattern of association, while in 2 countries-Bangladesh and India-poorer women were more likely to use LAPMs than wealthier women. The positive association between wealth and LAPM use was found most consistently in the Latin American and the Caribbean countries in our sample. These findings can help program implementers respond better to women's needs for modern contraception, especially in reaching women from lower- and middle-income households.

Unmet need of long-acting and permanent family planning methods among women in the reproductive age group in shashemene town, Oromia region, Ethiopia: a cross sectional study.

BackgroundMany countries continue to have high fertility rates and most of the predicted increase in the world’s population until 2100 comes from these countries. Among family planning methods, Long Acting and Permanent Methods are convenient for users and effectively prevent pregnancy. The objective of this study was to assess factors associated with unmet need of Long Acting and Permanent Methods of contraception among women in the reproductive age group (15-49) using contraception in health facilities of Shashemene town, Oromia Region, Ethiopia.MethodsFacility based cross sectional quantitative study and stratified sampling technique was used. Total of 382 females in reproductive age group were enrolled in the study in January 2012. Pretested, structured and close-ended questionnaire was used to interview study participants. Collected data was entered by using EPI Info 17 and analyzed by SPSS version 20 statistical software.ResultsUtilization of Long Acting and Permanent Methods (LAPMs) of contraception in Shashemene town was found to be 28.4 % (104/366). From study participants, 71.6 % (262/366) used short acting methods and from these current short acting users, 127(41.5 %) desired to use LAPMs and unmet need of LAPMs was 122(33.3 %). Factors significantly associated with unmet need of LAMPs of contraception were: Education of women (< secondary level) AOR [3.8, 95 % CI: 2.9, 7.6; P < 0.001]; lack of discussion between partners AOR [2.9, 95 % CI: 1.8, 9.6; P = 0.01]; lack of proper counseling for women AOR [5.3, 95 % CI: 1.7, 11.2; P = 0.04]; and women’s occupation as a housewife AOR [4.7, 95 % CI: 3.1, 11.3; P = 0.02].ConclusionUnmet need of LAPMs of contraception in health facilities in Shashemene town was high. Women education, partner discussion and proper client counseling were found the main factors associated women LAPMs utilization.

Importance of appropriate counselling in reducing early discontinuation of Norplant in a northern district of Bangladesh.

Bangladesh has achieved a considerable decline in fertility level in the past four decades through a strong family planning programme in spite of its poor social and economic growth. However, discontinuation of contraceptive methods and decline in the use of long-acting and permanent methods (LAPMs) are still the major concerns of the family planning programmes. This paper describes various factors that lead to the acceptance of the long-term method--Norplant and those that lead to early discontinuation. This descriptive, cross-sectional study was conducted in the Family Planning Association of Bangladesh (FPAB), Dinajpur, during March-June 2005 among 73 women who visited the clinic to remove their Norplant before its usual duration (5 years). The women were in the 25-31 years age-group--around two-thirds of them (57.5%) without formal education, and three-fourths of them (75.3%) were housewives. Most of them had been married for nine years, on average, and had two and/or more children. Sixty-seven percent of the women experienced regular menstruation, and 95% had used other contraceptive methods prior to using Norplant. Past users of Norplant were the single-most important source of information for about three-fourths of the women (74%); half of the women (51%) had discussed the method with their husbands, and majority (96%) of the husbands were informed about the women's decision on accepting the method before its implantation. All women were aware about the usual length of the effectiveness of Norplant. The most common reason for early removal of Norplant was menstrual disorder (59%), followed by desire for children (16%), husband's death, for abandonment or residing abroad (8%), anorexia, nausea, vomiting (7%), weight gain (4%), husband's objection (3%), and religious beliefs (3%). Service providers should properly counsel the couple before providing any contraceptive method, informing them about method-related side-effects and clearing any religious misconceptions. They should also explore the perception of women as well as their partners' desire for children; couples who would like to have a baby within a year or two can be encouraged to use a short-term method that can be more easily discontinued.

Demand for long acting and permanent methods of contraceptives and factors for non-use among married women of Goba Town, Bale Zone, South East Ethiopia.

BackgroundContraceptive use including short acting, long acting and permanent methods positively influence the socio-economic development of a nation by allowing families to space and limit their family size to their economic capacity. Demand for LAPMs of contraception as detrmined by utilization and unmet need for LAPMs of contraception can provide realiable information for providers.ObjectiveTo determine the utilization of long acting and permanent contraception and its associated factors among married women of Goba town, South East Ethiopia.MethodsA cross sectional community based study was conducted among 734 systematically selected married women of reproductive age in Goba town in September/ 2009. A structured and pretested, interview questionaire was used to collect data on socio-demographic, behavioral factors and data related to demand for LAPMs of contraception. Data were analyzed using EPI INFO and SPSS version 16.ResultThe demand for Long Acting and Permanent Methods (LAPMs) of contraception was 18.1%. Utilization of LAPMs of contraception in the town was 64 (8.7%) and the unmet need for LAPMs was 69 (9.4%). Information on LAPMs in the town was 636 (86.6%). Media (radio and television) was the major sources of information 641 (87.3%). The use of LAPMs was significatly associated with ever use AOR[17.43, 95% CI:9.19, 33.03], number of times discussions made on methods AOR[4.6, 95% CI: 1.72,12.17] and main decider of using methods AOR[ 2.2, 95% CI:1.03, 4.65]. It was not associated with socio-demographic variables.Conclusion and recommendationThe utilization of LAPMs in the town was less although higher than the Ethiopian demographic and health survey 2005 result. Moreover, there was a considerable unmet need. Increase the method mix of LAPMs by incorporating varaies of implnats in order to increase utilization. Proper counseling of client and partners discussion were some of the recommendation forwarded.

Factors impacting knowledge and use of long acting and permanent contraceptive methods by postpartum HIV positive and negative women in Cape Town, South Africa: a cross-sectional study

BackgroundThe prevention of unintended pregnancies among HIV positive women is a neglected strategy in the fight against HIV/AIDS. Women who want to avoid unintended pregnancies can do this by using a modern contraceptive method. Contraceptive choice, in particular the use of long acting and permanent methods (LAPMs), is poorly understood among HIV-positive women. This study aimed to compare factors that influence women's choice in contraception and women's knowledge and attitudes towards the IUD and female sterilization by HIV-status in a high HIV prevalence setting, Cape Town, South Africa.MethodsA quantitative cross-sectional survey was conducted using an interviewer-administered questionnaire amongst 265 HIV positive and 273 HIV-negative postpartum women in Cape Town. Contraceptive use, reproductive history and the future fertility intentions of postpartum women were compared using chi-squared tests, Wilcoxon rank-sum and Fisher's exact tests where appropriate. Women's knowledge and attitudes towards long acting and permanent methods as well as factors that influence women's choice in contraception were examined.ResultsThe majority of women reported that their most recent pregnancy was unplanned (61.6% HIV positive and 63.2% HIV negative). Current use of contraception was high with no difference by HIV status (89.8% HIV positive and 89% HIV negative). Most women were using short acting methods, primarily the 3-monthly injectable (Depo Provera). Method convenience and health care provider recommendations were found to most commonly influence method choice. A small percentage of women (6.44%) were using long acting and permanent methods, all of whom were using sterilization; however, it was found that poor knowledge regarding LAPMs is likely to be contributing to the poor uptake of these methods.ConclusionsImproving contraceptive counselling to include LAPM and strengthening services for these methods are warranted in this setting for all women regardless of HIV status. These study results confirm that strategies focusing on increasing users' knowledge about LAPM are needed to encourage uptake of these methods and to meet women's needs for an expanded range of contraceptives which will aid in preventing unintended pregnancies. Given that HIV positive women were found to be more favourable to future use of the IUD it is possible that there may be more uptake of the IUD amongst these women.

Contraceptive Security: Incomplete Without Long‐Acting and Permanent Methods of Family Planning

This commentary reviews the importance of long-acting and permanent methods (LA/PMs) and considers why they are neglected in many national contraceptive security strategies and family planning programs. It also proposes recommendations for broadening method choice to include LA/PMs more fully and thereby increasing the ability of women and men to achieve their reproductive intentions.

Is 'planning' missing from our family planning services?

1The benefits of family planning, in developing countries in particular, extend beyond decreasing fertility and include poverty reduction, improved health for both mother and child, the promotion of gender equality by increasing women’s opportunities beyond reproductive and domestic activities, and environmental sustainability. 1 In addition, prevention of undesired pregnancies among HIV-positive women by eliminating unmet need for contraception is a highly cost-effective means of preventing mother-to-child transmission. 2 In South Africa, free contraceptives are available at public sector health care facilities, and contraception use is high: an estimated 65% of sexually active women use a method. 3 The method mix comprises predominantly short-acting methods – primarily injectable contraceptives. Long-acting contraceptives, such as the intra-uterine device (IUD), are highly effective among typical users owing to consistency of function, yet are underutilised in South Africa’s public sector facilities. Of importance, especially in South Africa’s high HIVprevalent setting, is that the IUD can be safely used on clinically well HIV-positive women. 4 The 2004 Demographic and Health Survey showed that 10% of sexually active women were sterilised, while less than 1% of women were using the IUD. 3 In preparation for an intervention aimed at improving contraceptive options, including long-acting and permanent methods (LAPM), for all postpartum women, we assessed women’s knowledge and attitudes to LAPM. We report on findings from our baseline survey, which have prompted the question: Where is the ‘planning’ in family planning services? Methodscross-sectional study, approved by the University of Cape Town