Determinants Of Discontinuation Of Contraceptive Methods Among Women At Kenyatta National Hospital

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.