Factors influencing use of long-acting versus short-acting contraceptive methods among reproductive-age women in a resource-limited setting

Abstract

BackgroundUnplanned pregnancy remains a common problem in many resource-limited settings, mostly due to limited access to modern family planning (FP) services. In particular, use of the more effective long-acting reversible contraceptive (LARC) methods (i.e., intrauterine devices and hormonal implants) remains low compared to the short-acting methods (i.e., condoms, hormonal pills, injectable hormones, and spermicides). Among reproductive-age women attending FP and antenatal care clinics in Uganda, we assessed perceptions and practices regarding the use of modern contraceptive methods. We specifically aimed to evaluate factors influencing method selection.MethodsWe performed a mixed-methods cross-sectional study, in which we administered structured interviews to 180 clients, and conducted 4 focus group discussions (FGDs) with 36 clients and 8 in-depth personal qualitative interviews with health service providers. We summarized quantitative data and performed latent content analysis on transcripts from the FGDs and qualitative interviews.ResultsThe prevalence of ever use for LARC methods was 23%. Method characteristics (e.g., client control) appeared to drive method selection more often than structural factors (such as method availability) or individual client characteristics (such as knowledge and perceptions). The most common reasons for choosing LARC methods were: longer protection; better child-spacing; and effectiveness. The most common reasons for not choosing LARC methods included requiring a client-controlled method and desiring to conceive in the near future. The most common reasons for choosing short-acting methods were ease of access; lower cost; privacy; perceived fewer side effects; and freedom to stop using a method without involving the health provider. The personal characteristics of clients, which appeared to be important were client knowledge and number of children. The structural factor which appeared to be important was method availability.ConclusionsOur results suggest that interventions to improve uptake of LARC among reproductive age women in this setting should consider: incorporating desired method-characteristics into LARC methods; targeted promotion and supply of LARC; and increased counselling, sensitization, and education.

Barriers to Uptake of Postpartum Long‐Acting Reversible Contraception: Qualitative Study of the Perspectives of Ugandan Health Workers and Potential Clients

“…; Tibaijuka et al. ), but this does not explain low levels of use in areas where LARCS have been made more widely available. The need to attend a health facility during menstruation and undress has been identified as a barrier to choosing the IUD, but this does not apply immediately after delivery, when many women are in a health facility already and this should be an ideal time for IUD insertion (Robinson et al.…”

“…A survey of women attending antenatal or family planning clinics in Uganda found that a common reason for not choosing a LARC was women's desire to be able to control the method themselves, without involving a health provider (Tibaijuka et al. ). A qualitative study of women seeking post‐abortion services in Kampala found that other important barriers to use of LARCs were the views of other family members and misinformation from health workers (Kakaire et al.…”

Determinants of Long-Term Contraceptive Method Use in Madiun, East Java: Application of Social Cognitive Theory

“…Informasi yang berkembang dengan baik akan meningkatkan pengetahuan yang baik di masyarakat. Sikap positif terhadap penggunaan MKJP yang diperoleh melalui pengetahuan yang baik tentang MKJP akan meingkatkan potensi untuk menggunakan MKJP (Tibaijuka et al, 2017;Gebremariam A dan Addissie, 2014) Penulis menyimpulkan bahwa sikap yang positif dapat meningkatkan perilaku kesehatan yang baik pula dengan upaya peningkatan pengetahuan bagi masyarakat. Peningkatan pengetahuan diiringi dengan penyebaran informasi yang tepat terhadap upaya peningkatan perilaku kesehatan akan memengaruhi sikap yang diperoleh untuk dapat bernilai positif.…”

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).…”