contraceptive discontinuation in urban honduras janine barden-o’fallon, phd ilene speizer, phd...
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Contraceptive discontinuation in urban Honduras
Janine Barden-O’Fallon, PhDIlene Speizer, PhD
University of North Carolina at Chapel Hill, USA
29 September 2009
Overview
Results from a one-year follow-up study with reversible method users conducted in Honduras, 2006-2007
The study was funded by USAID and implemented by MEASURE Evaluation in collaboration with Programas para el Desarollo de Infantes y Mujeres (PRODIM)
Contraceptive Discontinuation
Common, though varies by country
Most common during first 12 months of use
Contributes to unmet need
Can lead to unplanned pregnancy and unwanted births, resulting in negative public health outcomes
Objective
To determine how multiple factors affect contraceptive discontinuation among users of temporary methods over a one-year period Demographic characteristics
Fertility motivations
Partner engagement
Quality of FP services
Experience of side effects
Method characteristics
Study Sites
Data: Panel study collected in 2 rounds
Baseline exit interviews with 800 women aged 15-44, attending a FP appointment in selected health facilities in which they received the injectable, IUD, or oral contraceptive pill Women were both new and continuing users
There were no quotas by type of method
Follow-up interviews completed with 671 (84%) 1 year later
Study sample at baseline (n=671)
Young (94% under age 35)
Educated (30% reached secondary or higher)
Parity >/= 1
Married/in union (89%)
Urban residents (77%)
Desire to space a birth 2+ years (50%) or no more children (34%)
Method use by status of user at Baseline; N=671
Continuing (n=52%)
New Adopter (n=13%)
New Switcher (n=35%)
0
10
20
30
40
50
60
70
80
Injectable (72%)
IUD (21%)
Pill (7%)
Discontinuation Rate of Baseline Method, N= 324
Baseline Method
@ 6 months
@ 12 months
Injectable 0.25 0.50
IUD 0.16 0.31
Pills 0.22 0.44
TOTAL 0.23 0.45
Results: Discontinuation was common…
Transition to First Episode of Non-Use, N= 324
Baseline Method
@ 6 months
@ 12 months
Injectable 0.14 0.30
IUD 0.07 0.12
Pills 0.06 0.28
TOTAL 0.12 0.25
…But many switched to another method
Multivariate analysis: Cox proportional hazards models Model 1: Time until discontinuation of
baseline method
Model 2: Time until first episode of non-use of any method (Model 2)
Covariates: demographic characteristics, fertility motivations and family engagement, experience of side effects, baseline service quality, and user status at baseline
Stratified by baseline method
Demographic characteristics
Age 25+ Parity 0/1 Not in union at FU
Urban
0
0.5
1
1.5
2
2.5
1.34 1.35
1.97
2.27
0.74
Model 1
Model 2
**
*
**
***
***
Fertility motivations & family engagement
0
0.5
1
1.5
2
2.5
1.4
0.75
2.04
Model 1
Model 2
***
0.75*
*
**
Experience with side effects
Heavy bleeding
Weight gain Dizziness Interfered with daily
life
0
0.5
1
1.5
2
2.5
2.07
1.85
1.561.79
1.94
Model 1
Model 2
***
Service quality
Felt provider
answered all ques-
tions0
0.5
1
1.5
2
2.5
0.76
Model 1
Model 2*
Discussion
More than 4 out of 10 women discontinued the baseline method
Living in rural areas may limit ability to successfully switch methods
Service quality had little effect on discontinuation
Family and friends may support continuation
MEASURE Evaluation is funded by the U.S. Agency for
International Development and is implemented by the
Carolina Population Center at the University of North
Carolina at Chapel Hill in partnership with Futures Group
International, ICF Macro, John Snow, Inc., Management
Sciences for Health, and Tulane University. The views
expressed in this presentation do not necessarily reflect
the views of USAID or the United States Government.
Thank you