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

Abstract

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.

Method Shifting from Long to Short Term Contraceptives and its Associated Factors among Reproductive Age Women, Northwest Ethiopia, 2018

“…The nding was in line with the study conducted in Egypt 46% [20]. This nding was lower as compared with those studies conducted in Vietnam 80 % [21] Malawian 58% [9], Zambia 89% [10], and Vietnam 66.7% [22]. The possible justi cation might be due to the fact that Ethiopian government has given more emphasis for LACM use, through nurses, midwives and health extension programs even at lower level of the health care system (primary health care unit).…”

“…A study conducted among IUCD users in Pakistan showed that 33.3% of women shifted their method of choice to short term methods [8]. Another study done in Malawi showed that 58% of woman switched to more effective method, 24% switched to similarly effective methods and 18% switched to less effective methods [9]. A study in Lusaka, Zambia showed that among 145 implant users 13% shifted the methods, from these 89% shifted to short term family planning methods.…”

Socio-economic and Socio-cultural Factors Influencing Contraceptive Uptake among Women of Reproductive Age at Kahe Ward in Moshi, Kilimanjaro - Tanzania

“…The reasons for this are inadequate exposure to contraceptives and early marriages. Nonetheless, the contraceptive use was substantially lower among women in polygamous marriages than among those in monogamous ones in Malawi (Kopp et al, 2017). The study suggests that characteristics of polygamous couples have caused polygamous women to be more resistant to birth control use than monogamous women.…”

Padrões e determinantes das descontinuidades contraceptivas no uso de pílula oral, hormonal injetável e preservativo masculino

“…Pode ser que o preservativo masculino esteja sendo usado mais como "reforço" de outros métodos contraceptivos, ou seja, tem um caráter provisório. A mulher ou o casal, quando têm oportunidade ou necessidade, trocam esse método, e geralmente por um mais eficaz, assim como observado em outros contextos (Goldstein, Upadhyay, Raine, 2013;Kopp et al, 2017). Estudo que analisou a dinâmica da troca entre o uso do preservativo masculino e contraceptivos hormonais em mulheres que iniciaram o uso de métodos contraceptivos hormonais, observou que o uso do preservativo masculino e dos métodos hormonais ao longo do tempo foi dinâmico, e a mulher experienciou alternâncias importantes entre os dois métodos contraceptivos (Goldstein, Upadhyay, Raine, 2013).…”

“…(Ali, Cleland, 2010b). De fato, a maior porcentagem de descontinuidade do uso do preservativo masculino é para um MAC mais eficaz (Kopp et al, 2017).…”