Long acting reversible contraception use and associated factors among married women of reproductive age in Nepal

Abstract

Modern contraceptives are highly effective and proven means of preventing unintended pregnancy and reducing maternal mortality. Social and economic characteristics are some of the key determinants of health and utilization family planning. However, studies examining the factors associated with utilization of long acting reversible contraception (LARC) are limited in Nepal. This study assessed the factors associated with utilization of LARC methods among married women of reproductive age in Nepal. Secondary data analysis was conducted using the 2016 Nepal Demographic and Health Survey (NDHS). A logistic regression model examined the association of socioeconomic, demographic, or fertility related characteristics with the use of LARCs among 9875 ever married women of reproductive age. The overall utilization rate of LARC in this study was 4.7%. Women in the age group of <25 years (AOR: 0.65, 95% CI: 0.45–0.92) and 25–35 years (AOR: 0.70, 95% CI: 0.56–0.89), having husbands with primary education (AOR:0.71; 95%CI: 0.64–0.84) and no education (AOR: 0.54; 95%CI: 0.38–0.73), belonging to Janajatis (AOR: 0.55; 95%CI: 0.42–0.71) and Newars (AOR: 0.29; 95%CI: 0.19–42), poor wealth quintile (AOR: 0.60; 95% CI: 0.45–0.86) had negative association with LARC use. On the other hand, women having their husband as a skilled worker (AOR: 1.49; 95%CI: 1.10–2), having two or less than two children (AOR: 1.46; 95% CI: 1.15–1.186), and having desire for children in future (AOR: 3.24; 95% CI: 2.29–4.57) had positive association with the use of LARC. In this study, younger women’s age, low or no husband’s education, from indigenous community such as Janajati and Newer, being in lowest wealth quintile negatively influenced the use of LARC. Conversely, women having her husband as skilled worker, parity less than two, and desire of having future children, positively influenced the use of LARC. The study highlights the need to reach women who were in the lower socioeconomic background to improve LARC use.

Perceptions on abortion and long-acting contraceptive use among women of reproductive age in selected Nigerian States: a cross-sectional study

“…The women who belonged to households in the highest wealth quintile were less likely to use LARC compared to women who belonged to the lowest wealth quintile. The study contradicts ndings in Nepal, Ethiopia, Iran and Nigeria [18,42,46,47], as these studies found a positive association between LARC use with higher wealth quintile.…”

“…The low Contraceptive Prevalence Rate (CPR) of 6.8% reported in Nigeria in 1999 [18], and currently, 17% [19] is the direct cause of the high abortion rate [20]. Contraceptive empowers women and couples to make decisions about the timing and spacing of pregnancies [21], and it also can prevent one in every three maternal deaths by allowing women to space births, avoid unintended pregnancies and abortions, and stop childbearing when they achieve their preferred family size [18,20,22] because it's their right to have access to modern contraceptive and maternal health care regardless of age, income, marital status, and parity [23]. The unfettered access and use of effective methods of contraception, especially the Long-Acting Reversible Contraceptives (LARC), will help to reduce this global burden of disease and mortality emanating from unsafe abortion [24].…”

“…There is no evidence of a delay in the return of fertility following removal or expulsion of these contraceptives [29] The low use of LARC can also be attributed to the various power and gender-related factors linked to socio-demographic and economic characteristics including marital status, whether the pregnancy was as an outcome of rape [30], woman's economic dependence and educational level [30,31], partner and parental support [31], societal factors including religion and social norms [32,33], the healthcare systems, abortion laws and stigma on premarital and extra-marital sex [30,34]. Implantable long-acting hormonal contraceptives, such as intrauterine devices (IUDs) and subcutaneous implants, will last for years as birth control methods that offer effective long-term contraception without the need for consumer intervention [18,20,21,35]. They are safer, cost-effective and have lower failure rates because of their low reliance on user compliance for e cacy compared to short-acting contraceptives [20,[36][37][38].…”

“…They are safer, cost-effective and have lower failure rates because of their low reliance on user compliance for e cacy compared to short-acting contraceptives [20,[36][37][38]. Studies have found that LARC can contribute to reducing subsequent unintended conceptions and that women having an abortion may be highly motivated to secure contraception, particularly LARC [18,38]; also, policies considering for heavy subsidization and upfront cost have been advocated [39] to ease the nancial burden of the users. Although access to safe abortions and effective contraceptives has increased worldwide, accessibility is still a great barrier in many Low-and Middle-Income Countries (LMIC), including Nigeria.…”

The Utilization of Long-Acting Reversible Contraception and Associated Factors Among Women in Indonesia

“…In 2017, IUDs and implants were used by only less than 10% of women in reproductive age. Gallo, 2019;Austad, Shah, & Rohloff, 2018;Bhandari, Pokhrel, Gabrielle, & Amatya, 2019;Dempsey, Billingsley, Savage, & Korte, 2012;Finer, Jerman, & Kavanaugh, 2012;Harzif, Mariana, Malik, Silvia, & Lovita, 2019;Weber, Briggs, & Hanson, 2017), parity (Asad et al, 2019;Bhandari et al, 2019;Finer et al, 2012;Mazzei et al, 2019), family welfare (Adedini et al, 2019;Bhandari et al, 2019;Fekadu, Omigbodun, Roberts, & Yalew, 2019), women's knowledge (Dempsey et al, 2012;Harzif et al, 2019;Mazzei et al, 2019), women's education (Adedini et al, 2019;Asad et al, 2019;Mazzei et al, 2019;Ontiri et al, 2019;Secura & McNicholas, 2013), husband education (Bhandari et al, 2019), women's occupation (Adedini et al, 2019;Fekadu et al, 2019), husband's occupation (Bhandari et al, 2019), religion (Mazzei et al, 2019;Ontiri et al, 2019), desire for children in the future (Bhandari et al, 2019;Ontiri et al, 2019), accessibility (Secura & McNicholas, 2013) were documented as significant predictors of LARC used. Health related factors for LARC adoption were health workers skills (Harzif et al, 2019;Ontiri et al, 2019), counselling (Mazzei et al, 2019;Secura & McNicholas, 2013) and history of abortion (Fekadu et al, 2019)…”