Twelve-month contraceptive continuation among women initiating short- and long-acting reversible contraceptives in North Kivu, Democratic Republic of the Congo

Abstract

ContextDespite the inclusion of sexual and reproductive health (SRH) services in the minimum standards of health care in humanitarian settings, access to SRH services, and especially to contraception, is often compromised in war. Very little is known about continuation and switching of contraceptive methods in these settings. An evaluation of a contraceptive services program in North Kivu, Democratic Republic of the Congo (DRC) was conducted to measure 12-month contraceptive continuation by type of contraceptive method (short-acting or long-acting).MethodsA stratified systematic sample of women who initiated a contraceptive method 12–18 months prior to data collection was selected retrospectively from facility registers. A total of 548 women was interviewed about their contraceptive use: 304 who began a short-acting method (pills, injectables) and 244 who began a long-acting method (intra-uterine devices, implants). Key characteristics of short-acting method versus long-acting method acceptors were compared using chi-square statistics for categorical data and t-tests for continuous data. Unadjusted and adjusted Cox proportional hazard ratios were estimated to assess factors associated with discontinuation.ResultsAt 12 months, 81.6% women reported using their baseline contraceptive method continuously, with more long-acting than short-acting contraceptive acceptors (86.1% versus 78.0%, p = .02) continuing contraceptive use. Use of a short-acting method (Hazard ratio (HR) 1.74 [95%CI 1.13–2.67]) and desiring a child within two years (HR 2.58 [95%CI 1.45–4.54]) were associated with discontinuation within the first 12 months of use. The vast majority (88.3%) of women reported no prior contraceptive use.ConclusionThis is the first study of contraceptive continuation in a humanitarian setting. The high percentages of women continuing contraceptive use found here demonstrates that women will choose to initiate and continue use of their desired contraceptive method, even in a difficult, unstable and low contraceptive prevalence setting like North Kivu.

Discontinuation and Switching of Postpartum Contraceptive Methods Over Twelve Months in Burkina Faso and the DRC: A Secondary Analysis of the Yam-Daabo trial

“…All of these reasons explain why, in almost all studies, such as the Casey et al, study in the DRC (86.1% versus 78.0%) the rate of continuation of methods is higher in users of long-acting methods (implants and IUDs) than in users of short-acting methods (pills and injectables) [17]. In Senegal, in 2015, a study of 6927 women of childbearing age living in six urban sites showed that implants had the lowest 12-month discontinuation rate (6.3%), followed by intrauterine devices (IUDs) (18.4%).…”

“…There are also other factors which were reported by previous authors as in uencing contraceptive continuation. Among these factors we have the use of a short-acting method, the desire for pregnancy within two years [8], little or no sexual relations [9] and other socio-economic and demographic factors such as age, marital status, income, mass media-exposure, and partner involvement in decision making, and service quality [10][11][12].…”

“Due to the side effects she has when using the method it will be difficult for nurses to convince her to continue with that method. That’s why I said she will leave with another method.”: Family planning providers and contraceptive users in Rwanda do not consider discontinuation an option

“…Globally, that could mean that 25 million of the 75 million unintended births are due to contraceptive discontinuation (2). Studies report discontinuation rates at 6-56% after just 12 months of contraceptive use (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Discontinuation, while still in need of pregnancy protection, increases with time beyond the most common measure of after 12 months of use (3,9,13).…”

“…Discontinuation has been reported as significantly more common in sub-Saharan Africa as compared to other world regions (14). Often the most common reasons for discontinuation for those who wish to continue to prevent pregnancy is method related -such as health concerns or the experience of side effects (3,7,9,12,15).…”

“…While researchers examining switching after one year of use found rates between 10% and 80%. (3,7,9,12) Researchers have noted that switching occurs at a lower level in sub-Saharan Africa countries than in other regions of the world (3).…”