dc.description.abstract | Introduction and literature review
Contraceptive prevalence rate in Kenya is at 58% as per the 2014 Kenya Demographic Health
Survey. Several factors lead to discontinuation and switch of contraceptives. These include
adverse effects, contraceptive failure, need for pregnancy, infrequent sexual intercourse, need for
a more effective method, lack of access, unaffordability and inconvenience during use.
Discontinuation rate as per the 2008/2009 KDHS for one year was 35.8%.
Objectives
The main objective of the study was to find out the determinants of discontinuation and
switching of hormonal and IUD contraceptive methods.
Methodology
The study was cross-sectional hospital based, where data was collected by use of an interviewer
administered questionnaire within Clinic 66 of Kenyatta National Hospital. This was after
Ethical approval was obtained from Kenyatta National Hospital/University of Nairobi, Ethics
and Research Committee. Data was collected within the period, 1st May 2015 to 30th June 2015,
where 400 women were interviewed. The data was then analyzed by use of the statistical
software, SPSS Version 20.
Results
The study population mainly comprised married women with a mean age of 31.45 (± 6.40) years,
whom most had secondary education and above. Those who were unemployed were 35.8% with
the rest being either self-employed or in formal employment. Most of the women were Christians
with only 0.2% being Muslims. Most of the women had 1-2 children (65.3%). Least adverse
effects was the most cited reason for choosing the contraceptive method of use while
unaffordability/unavailability was the least concern. Discontinuation rate by the time of study in
the study population was 60.8%, with adverse effects as the most cited reason for
discontinuation. Spousal disapproval and unaffordability/unavailability were never a cause of
discontinuation. Among the adverse effects, menstrual irregularities were the most common
reasons why women discontinued use of a contraceptive method. The method of contraception
and presence of co-morbidity were the factors associated with discontinuation of a contraceptive.
Survival analysis showed that depot injection and Jadelle® had the highest median months of use
and Impanon® the least. Adherence case indexing showed that 74.7% of Combined Oral
Contraceptives users had good adherence.
Conclusion
Multiple reasons for discontinuation of contraceptive use include primarily concerns for adverse
effects, use inconvenience, desire to become pregnant, contraceptive failure, and doctor’s advice.
Comorbid conditions and contraception method are statistically associated with the
discontinuation of contraceptive use.
Recommendations
Reproductive Health programs need to come up with more detailed programs that address the
high levels of discontinuation of contraception use by women who are still in need. The factors
underlying the discontinuations need to be addressed thoroughly during the inception of
contraceptive services, and counseling continued at each visit for the services. Studies need to be
done to determine the temporal relationship between hormonal contraceptive use and onset of the
comorbid conditions. Studies following those who discontinue use of contraceptives while still in
need of the services need to be done to determine the outcome of such action. | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |