Baiden F, Mensah G P, Akoto N O, Delvaux T, Appiah P C
Epidemiology Unit, Ensign College of Public Health, Kpong, ER, Ghana.
Faculty of Public Health and Allied Sciences, Catholic University College of Ghana, Fiapre, BAR, Ghana.
BMC Womens Health. 2016 Jun 6;16:31. doi: 10.1186/s12905-016-0310-x.
Covert contraceptive use (CCU) in sub-Saharan Africa is an indication of women's inability to exercise autonomy in their reproductive choices. The aim of this study was to assess the prevalence and determinants of CCU among a sample of FP clients in a municipality of Ghana.
We conducted a mixed method study among women attending a public reproductive health clinic in Sunyani, a city of over 250,000 inhabitants in Ghana. An initial survey inquired into sociodemographic characteristics, use of family planning (FP) methods and partner awareness of contraceptive use. The predictors of CCU were explored using logistic regressions. We used the findings to develop a guide which we applied in-depth interviews and focus group discussions with attendants at the same facility. Qualitative data analysis was conducted using a framework approach.
We interviewed 300 women, 48 % of whom were aged between 26-33 years. The injectable was the most widely used method (56 %). The prevalence of CCU was 34 %. In multivariate analysis, single women were more likely to practice CCU than married or co-habiting women (Adjusted OR = 12.12, 95 % C.I. 4.73-31.1). Muslim and traditionalist women were similarly more likely to practice CCU than non-Muslim, non-traditionalist (Adjusted OR = 4.56, 2.29-9.06). Women who preferred to have their first or next child in 4 or more years from the time of the interview were more likely to be in CCU than women who intended to have children within 4 years of the interview (2.57; 1.37-4.83). Single women saw in covert use a statement of their social autonomy. To succeed in CCU, women wished that clinic attendance cards would not be given to them to keep at home. Though many participants saw in CCU a source of anxiety, they expected health workers to consider it and uphold confidentiality in the provision of services.
Covert contraceptive use was high in this municipality and being single was the strongest predictor of the practice. Providers of FP services should reflect on how to adequately address the challenges faced by women who practice CCU.
在撒哈拉以南非洲，秘密使用避孕药具（CCU）表明女性在生殖选择上无法行使自主权。本研究旨在评估加纳一个城市计划生育服务对象样本中CCU的患病率及其决定因素。
我们在加纳拥有超过25万居民的城市苏尼亚尼的一家公共生殖健康诊所对女性进行了一项混合方法研究。初步调查询问了社会人口学特征、计划生育（FP）方法的使用情况以及伴侣对避孕使用的知晓情况。使用逻辑回归探索CCU的预测因素。我们利用研究结果制定了一份指南，并在同一机构与服务对象进行了深入访谈和焦点小组讨论。采用框架方法进行定性数据分析。
我们采访了300名女性，其中48%的年龄在26 - 33岁之间。注射剂是使用最广泛的方法（56%）。CCU的患病率为34%。在多变量分析中，单身女性比已婚或同居女性更有可能秘密使用避孕药具（调整后的比值比 = 12.12，95%置信区间4.73 - 31.1）。与非穆斯林、非传统主义者相比，穆斯林和传统主义女性同样更有可能秘密使用避孕药具（调整后的比值比 = 4.56，2.29 - 9.06）。与打算在访谈后4年内生育孩子的女性相比，那些希望在访谈后4年或更长时间生育第一个或下一个孩子的女性更有可能秘密使用避孕药具（2.57；1.37 - 4.83）。单身女性将秘密使用视为其社会自主性的一种体现。为了成功秘密使用避孕药具，女性希望诊所不要给她们发放门诊卡让她们带回家。尽管许多参与者认为秘密使用避孕药具会带来焦虑，但她们期望医护人员在提供服务时考虑到这一点并保密。
该城市秘密使用避孕药具的情况很普遍，单身是这种行为最有力的预测因素。计划生育服务提供者应思考如何充分应对秘密使用避孕药具的女性所面临的挑战。
