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

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

Getting Intentional about Intention to Use: A Scoping Review of Person‐Centered Measures of Demand

“…The fact that only two papers looked at ITU in the context of counseling interventions reinforces an observation made by Raine et al (2011): there has been little attention on how to support women with low intentions in clinical settings. 4 Where papers used ITU to assess the relationship and causal pathways between ITU and use of contraceptives, five prospective cohort studies have found that intention to practice contraception is a strong predictor of subsequent use in Bangladesh, Ghana, India, Morocco, and the USA (Curtis and Westoff 1996;Roy et al 2003;Callahan and Becker 2014;Lori et al 2018;Tang et al 2016;Johnson et al 2019). Ross and Winfrey's (2001) secondary analysis of DHS data in 27 countries found that for each increase of one percentage point in stated ITU contraceptives, there was nearly a 1% rise in the actual use of contraceptives.…”

“… 2003 ; Ross and Winfrey 2001 ; Callahan and Becker 2014 ; Lori et al. 2018 ; Tang 2016 ; Johnson et al. 2019 ; Adelman, Free, and Smith 2019 ; Raine et al.…”

“…It may be particularly relevant in assessing programs focused on ideational change and it may help distinguish between women within the category of unmet need. By synthesizing the evidence, five prospective cohort studies have found that intention to practice contraception is a strong predictor of subsequent use and suggests it has the potential to predict contraceptive uptake and use in its own right (Curtis and Westoff 1996;Roy et al 2003;Callahan and Becker 2014;Lori et al 2018;Tang et al 2016;Johnson et al 2019). However, its definition and operationalization have been underelaborated and inconsistent.…”

Cross-sectional assessment of government health center needs to implement long-acting reversible contraception services in rural Rwanda

“…Client-side barriers to LARC uptake, which are particularly common in rural areas, include lack of knowledge (particularly about the IUD) [ 6 , 8 – 13 ]; lack of male involvement in family planning [ 8 , 14 – 17 ]; concerns about side-effects; myths and misconceptions [ 18 , 19 ]; and concerns about negative effects on sexual intercourse [ 18 ]. Provider-side barriers include lack of LARC knowledge and training (particularly with the IUD) [ 8 , 9 , 20 , 21 ].…”

Assessment of government health center needs to implement long-acting reversible contraception services in rural Rwanda

“…In rural areas, < 1.5% use the copper IUD and 15% use the implant (7). Client-side barriers to LARC uptake, which are particularly common in rural areas, include lack of knowledge (particularly about the IUD) (6,(8)(9)(10)(11)(12)(13); lack of male involvement in family planning (8,(14)(15)(16)(17); concerns about side-effects; myths and misconceptions (18,19); and concerns about negative effects on sexual intercourse (18). Provider-side barriers include lack of LARC knowledge and training (particularly with the IUD) (8,9,20,21).…”