Postnatal contraception discontinuation: different methods, same problem

Singata‐Madliki, Mandisa; Dekile-Yonto, Nolusindiso; Hofmeyr, G Justus; Lawrie, Theresa A

doi:10.1136/bmjsrh-2017-101846

Cited by 3 publications

(6 citation statements)

References 3 publications

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“…We found poorer levels of rst-method continuation than those found in other SA studies [7,11,14,22,51]. These higher rates of discontinuation in comparison to LARC methods can be explained by the ease with which SAM can be discontinued (without the intervention of a healthcare provider) In addition, it requires greater adherence (daily adherence for oral pills) [23,33].…”

Section: Discussionmentioning

confidence: 62%

“…Although contraceptive use is relatively high, most SA studies report low continuation of contraceptives particularly, short-acting methods (SAM), ranging from as low as 40% for injectables [5,[7][8][9][10][11][12]. LARC methods such as the IUD and implant, generally have higher continuation rates of between 58-94% [5,[13][14][15][16]. This is due to LARC methods needing infrequent contact with a provider for insertion and removal, resulting in fewer opportunities for method discontinuation.…”

mentioning

confidence: 99%

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Contraceptive continuation among women of reproductive age utilising city of Cape Town family planning services

Naidoo,

Harries,

Zweigenthal

2024

Preprint

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Background There is a need to provide comprehensive contraceptive services that are consistent and address the requirements of women who are at risk of unintended pregnancy. This study describes characteristics of contraceptive users accessing family planning services and their contraceptive method usage patterns, focusing on continuation, at public clinics in Cape Town, South Africa. Methods The study reviewed the 2017 routinely collected data on contraceptive users (n = 217 274), aged 15–49 years accessing services across 102 public clinics. We calculated all method continuation and method-specific continuation for all hormonal contraceptive methods, using novel measures of ascertaining contraceptive continuation suited to routine data. Multi-variate analysis was used to examine the relationship between sociodemographic and health characteristics with contraceptive continuation with p-values < 0.05 considered statistically significant. Results Of the 217 274 women, 95.6% used short acting methods (68.2% injectables, 9.1% oral pills, 18.2% male and female condoms), while < 5% used long-acting reversible methods (implant 3.9%, intrauterine device 0.4%). The all-method method continuation proportion was 39.5%. Among specific methods, norethisterone enanthate injectable had the lowest continuation proportion at 8%, followed by the oral pill at 11%. These two methods are the most favoured contraceptive options among younger women aged 15–24). Contraceptive continuation was associated with dual method use (OR: 1.78; 95% CI: 1.74–1.84), older age (25–49) (OR: 1.16; 95% CI: 1.13–1.18) and had reduced odds if a user was on treatment for TB (OR: 0.64; 0.57–0.73). Conclusions Both method-specific and all-method contraceptive continuation were low, which indicates high rates of contraceptive method discontinuation without women switching their method. This may point to issues requiring attention at health provider, health system and contraceptive user levels. Expanding patient-centred counselling and education, ongoing in-service education of health providers, and inventory monitoring systems to address issues such as stockouts are needed.

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Section: Discussionmentioning

confidence: 62%

mentioning

confidence: 99%

Contraceptive continuation among women of reproductive age utilising city of Cape Town family planning services

Naidoo,

Harries,

Zweigenthal

2024

Preprint

View full text Add to dashboard Cite

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“…Our finding was different from Malawian study, where women who reported long-acting methods and injectable use at 3 months post-delivery were more likely to continue compared to those using pills, condoms, traditional methods [ 2 ]. It also differs from the South Africa that reported high rate of implant continuation at 12 months at a rate of 86% [ 7 ]. The difference in findings could be explained by the differences in characteristics between the studied population especially the cultural barriers.…”

Section: Discussionmentioning

confidence: 96%

“…Breastfeeding practices and beliefs about return of menses as a marker of fertility resumption during the postpartum period, makes it difficult for women to determine their fertility risk. Thus, women are less motivated to start contraceptive use while breastfeeding [ 6 , 7 ]. Previous investigators have demonstrated that women who discontinue contraception use during the postpartum period may opt not to use any method (contraceptive discontinuation) or switch to different modern method (method switching) which is less effective than the previous method at preventing pregnancy, and thereby exposes women to risk of unintended pregnancy, abortions and mistimed pregnancies/births [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of contraceptive discontinuation among postpartum women in Arusha region, Tanzania

Mahande

Sato

Amour

et al. 2021

Contracept Reprod Med

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Background Postpartum contraceptive discontinuation refers to cessation of use following initiation after delivery within 1 year postpartum. Discontinuation of use has been associated with an increased unmet need for family planning that leads to high numbers of unwanted pregnancies, unsafe abortion or mistimed births. There is scant information about contraceptive discontinuation and its predictors among postpartum women in Tanzania. This study aimed to determine predictors of contraception discontinuation at 3, 6, 12 months postpartum among women of reproductive age in Arusha city and Meru district, Tanzania. Methods This was an analytical cross-sectional study which was conducted in two district of Arusha region (Arusha city and Meru district respectively). A multistage sampling technique was used to select 13 streets of the 3 wards in Arusha City and 2 wards in Meru District. A total of 474 women of reproductive age (WRAs) aged 16–44 years residing in the study areas were included in this analysis. Data analysis was performed using STATA version 15. Odds ratios (ORs) with 95% confidence interval (CI) for the factors associated with contraceptives discontinuation (at 3, 6 and 12 moths) were estimated in a multivariable logistic regression model. Results Overall, discontinuation rate for all methods at 3, 6, and 12 months postpartum was 11, 19 and 29% respectively. It was higher at 12 months for Lactational amenorrhea, male condoms and injectables (76, 50.5 and 36%, respectively). Women aged 40–44 years had lower odds of contraceptive discontinuation at 3 months as compare to those aged 16 to 19 years. Implants and pills users had also lower odds of contraceptive discontinuation compared to injectable users at 3, 6 and 12 months respectively. Conclusion Lactational amenorrhea, male condoms and injectables users had the highest rates of discontinuation. Women’s age and type of method discontinued were independently associated with postpartum contraceptive discontinuation. Addressing barriers to continue contraceptive use amongst younger women and knowledge on method attributes, including possible side-effects and how to manage complications is warranted.

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“…Breastfeeding practices and beliefs about return of menses as a marker of fertility resumption during the postpartum period, makes it di cult for women to determine their fertility risk. Thus, women are less motivated to start contraceptive use while breastfeeding (Borda and Winfrey, 2010;Singata-Madliki et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Predictors of Contraceptive Discontinuation among Postpartum Women in Arusha Region, Tanzania

Mahande

Sato

Amour

et al. 2020

Preprint

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BackgroundPostpartum contraceptive discontinuation refers to cessation of use following initiation after delivery within one year postpartum. Discontinuation of use has been associated with an increased unmet need for family planning that leads to high numbers of unwanted pregnancies, unsafe abortion or mistimed births. There is scant information about contraceptive discontinuation and its predictors among postpartum women in Tanzania. This study aimed to determine predictors of contraception discontinuation at 3, 6, 12 months postpartum among women of reproductive age in Arusha city and Meru district, Tanzania.MethodsThis was an analytical cross-sectional study which was conducted in two district of Arusha region (Arusha city and Meru district respectively). A multistage sampling technique was used to select 13 streets of the 3 wards in Arusha City and 2 wards in Meru District. A total of 474 women of reproductive age (WRAs) aged 16-44 years residing in the study areas were included in this analysis. Data analysis was performed using STATA version 15. Odds ratios (ORs) with 95% confidence interval (CI) for the factors associated with contraceptives discontinuation (at 3, 6 and 12 moths) were estimated in a multivariable logistic regression model.ResultsOverall, discontinuation rate for all methods at 3, 6, and 12 months postpartum was 11%, 19% and 29% respectively. It was higher at 12 months for Lactational amenorrhea, male condoms and injectables (76%, 50.5% and 36%, respectively). Women aged 40-44 years had lower odds of contraceptive discontinuation at 3 months as compare to those aged 16 to 19 years. Implants and pills users had also lower odds of contraceptive discontinuation compared to injectable users at 3, 6 and 12 months respectively.ConclusionLactational amenorrhea, male condoms and injectables users had the highest rates of discontinuation. Women’s age and type of method discontinued were independently associated with postpartum contraceptive discontinuation. Addressing barriers to continue contraceptive use amongst younger women and knowledge on method attributes, including possible side-effects and how to manage complications is warranted.

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Postnatal contraception discontinuation: different methods, same problem

Cited by 3 publications

References 3 publications

Contraceptive continuation among women of reproductive age utilising city of Cape Town family planning services

Contraceptive continuation among women of reproductive age utilising city of Cape Town family planning services

Predictors of contraceptive discontinuation among postpartum women in Arusha region, Tanzania

Predictors of Contraceptive Discontinuation among Postpartum Women in Arusha Region, Tanzania

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