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

Abstract

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.