Use of injectable hormonal contraceptives: diverging perspectives of women and men, service providers and policymakers in Uganda

Hyttel, Maria; Rasanathan, Jennifer; Tellier, Marianne; Taremwa, Willington

doi:10.1016/s0968-8080(12)40654-1

Cited by 25 publications

(34 citation statements)

References 18 publications

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“…The tailoring of the advice to understandings of individual needs is the approach that corresponds most closely to the preferences of the young women. In common with other research, 23 we found that failing to discuss possible side effects that were then experienced led to distrust of the contraceptive provider.…”

Section: How the Providers Thought About Side Effectssupporting

confidence: 83%

Young women’s experiences of side-effects from contraceptive implants: a challenge to bodily control

Hoggart

Newton

2013

Reproductive Health Matters

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In the UK, long-acting reversible contraceptives have been welcomed by sexual health policy-makers and many practitioners as a particularly effective way of preventing unintended pregnancy, especially teenage conception. However, little is known about women's individual experiences of these forms of contraception beyond limited data on retention rates and reasons for discontinuation. The main aims of this research were to gain a fuller understanding of why some young women have their implants removed, and what may help them maintain this method of contraception if they wish to do so. The contraceptive choices of 20 young women (aged 16-22) who had chosen the implant, and later discontinued it, were examined. They had experienced unacceptable side effects that they attributed to the implant, and interpreted as a threat to their bodily control, which they were not prepared to tolerate. These feelings were exacerbated if they then encountered delays after requesting removal. Although they remained concerned to avoid unintended pregnancy, they generally moved to a less reliable form of contraception following implant removal and felt discouraged from trying other long-acting contraception. We suggest that principles of contraceptive choice should include facilitating the discontinuation of unsatisfactory methods; implant removal should therefore be readily available when requested, regardless of the length of time the implant has been in place. Long-acting forms of contraception do not suit all women, and will not obviate the need for other forms of reproductive control, including legal abortion. © 2013 Reproductive Health MattersKeywords: contraception and unwanted pregnancy, long-acting reversible contraception, implants, reproduction, bodily control, United KingdomThe provision of effective and reliable contraception is vital in enabling women to assert control over their reproductive lives, and reproductive control has long been seen as a central component of feminist calls for women's bodily control.

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Section: How the Providers Thought About Side Effectssupporting

confidence: 83%

Young women’s experiences of side-effects from contraceptive implants: a challenge to bodily control

Hoggart

Newton

2013

Reproductive Health Matters

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“…While men and women are equally likely to be infertile, women are often blamed (Cui, 2010), and infertility has been associated with intimate partner violence (Ameh et al ., 2007; Dhont et al ., 2011a,b). Fears related to infertility may impact contraceptive use (Gebremariam and Addissie, 2014; Hyttel et al ., 2012), and infertility has been associated with high-risk sexual behaviors (Dhont et al ., 2011a,b). Limited access to infertility care in the developing world exacerbates these concerns (Asemota and Klatsky, 2015).…”

Section: Introductionmentioning

confidence: 99%

Estimating infertility prevalence in low-to-middle-income countries: an application of a current duration approach to Demographic and Health Survey data

et al. 2017

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STUDY QUESTIONCan infertility prevalence be estimated using a current duration (CD) approach when applied to nationally representative Demographic and Health Survey (DHS) data collected routinely in low- or middle-income countries?SUMMARY ANSWEROur analysis suggests that a CD approach applied to DHS data from Nigeria provides infertility prevalence estimates comparable to other smaller studies in the same region.WHAT IS KNOWN ALREADYDespite associations with serious negative health, social and economic outcomes, infertility in developing countries is a marginalized issue in sexual and reproductive health. Obtaining reliable, nationally representative prevalence estimates is critical to address the issue, but methodological and resource challenges have impeded this goal.STUDY DESIGN, SIZE, DURATIONThis cross-sectional study was based on standard information available in the DHS core questionnaire and data sets, which are collected routinely among participating low-to-middle-income countries. Our research question was examined among women participating in the 2013 Nigeria DHS (n = 38 948). Among women eligible for the study, 98% were interviewed.PARTICIPANTS/MATERIALS, SETTING, METHODSWe applied a CD approach (i.e. current length of time-at-risk of pregnancy) to estimate time-to-pregnancy (TTP) and 12-month infertility prevalence among women ‘at risk’ of pregnancy at the time of interview (n = 7063). Women who were 18–44 years old, married or cohabitating, sexually active within the past 4 weeks and not currently using contraception (and had not been sterilized) were included in the analysis. Estimates were based on parametric survival methods using bootstrap methods (500 bootstrap replicates) to obtain 95% CIs.MAIN RESULTS AND THE ROLE OF CHANCEThe estimated median TTP among couples at risk of pregnancy was 5.1 months (95% CI: 4.2–6.3). The estimated percentage of infertile couples was 31.1% (95% CI: 27.9–34.7%)—consistent with other smaller studies from Nigeria. Primary infertility (17.4%, 95% CI: 12.9–23.8%) was substantially lower than secondary infertility (34.1%, 95% CI: 30.3–39.3%) in this population. Overall estimates for TTP >24 or >36 months dropped to 17.7% (95% CI: 15.7–20%) and 11.5% (95% CI: 10.2–13%), respectively. Subgroup analyses showed that estimates varied by age, coital frequency and fertility intentions, while being in a polygynous relationship showed minimal impact.LIMITATIONS, REASONS FOR CAUTIONThe CD approach may be limited by assumptions on when exposure to risk of pregnancy began and methodologic assumptions required for estimation, which may be less accurate for particular subgroups or populations. Unrecognized pregnancies may have also biased our findings; however, we attempted to address this in our exclusion criteria. Limiting to married/cohabiting couples may have excluded women who are no longer in a relationship after being blamed for infertility. Although probably rare in this setting, we lack information on couples undergoing infertility treatment. Like other TTP measure...

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“…The majority of research that has highlighted the importance of speci c side-effects in LMICs has been qualitative. Across diverse settings, women report experiencing changes to menstrual bleeding, abdominal pain, weight gain, changes to sexual experience, and non-speci c "weakness" as in uencing their decision-making about contraception (13,(16)(17)(18)(19)(20)(21)(22). Though providing critical contextual data, qualitative data are unable to assess how widespread experiences are, how these experiences contribute to contraceptive use dynamics at a population level, and what side effects may be largely tolerated by women versus those that lead to discontinuation or switching.…”

Section: Introductionmentioning

confidence: 99%

Impact of Experiencing Specific Side-Effects on Contraceptive Switching and Discontinuation in Uganda: Results from a Longitudinal PMA Survey

Zimmerman¹,

Sarnak

Karp

et al. 2020

Preprint

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There is substantial evidence that contraceptive side effects are a major deterrent to consistent use of contraception but few studies in low- or middle-income countries explore the role that specific side-effects, rather than the general category of “side-effects and health concerns”, have on contraceptive dynamics. This study used population-based, longitudinal data to explore the effect that specific side-effects had on contraceptive continuation, discontinuation, and switching in Uganda. Methods Data for this study come from two rounds of PMA2020 data collection in Uganda PMA2020 Uganda’s sixth cross-sectional survey and a follow-up survey conducted one year later. The main outcomes of interest were discontinuation and switching among modern users of hormonal contraceptive methods at baseline (n=550). Multivariable multinomial logistic regressions assessed the association of reporting experiencing specific side effects (more bleeding, less bleeding, irregular bleeding, changes to sexual experience, and physical discomfort) with discontinuation and switching one year later, adjusting for socio-demographic characteristics, type of method, and length of use.Results One-third of hormonal contraceptive users reported experiencing side-effects at baseline. Reporting more bleeding increased the risk of discontinuation by 2.39 times (95% CI: 0.01-4.72). Experiencing irregular bleeding decreased the risk of switching by a factor of 0.40 (95% CI: 0.17-0.93). Changes to sexual experience or physical discomfort were both associated with increased relative risk of switching; reporting a change to sexual experience increased the relative risk of switching by a factor of 3.10 (95% CI : 0.97-9.10) and physical discomfort increased the relative risk by a factor of 1.75 (95% CI: 0.95-3.24). Wealth was significantly negatively associated with discontinuation while education was marginally significantly and positively associated with switching. Conclusions Greater attention should be paid to understanding the unique contributions of side effects to contraceptive behavior using population-based data. Not all side effects are associated with contraceptive discontinuation and switching, despite the experience of side effects being common. The experience of physical discomfort and changes to sexual experience, largely ignored in other research, were shown to affect use. Providing greater individualized care that includes information about common side effects and how they may impact daily life is necessary.

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Use of injectable hormonal contraceptives: diverging perspectives of women and men, service providers and policymakers in Uganda

Cited by 25 publications

References 18 publications

Young women’s experiences of side-effects from contraceptive implants: a challenge to bodily control

Young women’s experiences of side-effects from contraceptive implants: a challenge to bodily control

Estimating infertility prevalence in low-to-middle-income countries: an application of a current duration approach to Demographic and Health Survey data

Impact of Experiencing Specific Side-Effects on Contraceptive Switching and Discontinuation in Uganda: Results from a Longitudinal PMA Survey

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