Jhpiego, Johns Hopkins University Affiliate, Nairobi, Kenya.
Department of Health Sciences/Global Health, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands.
PLoS One. 2020 Nov 5;15(11):e0241605. doi: 10.1371/journal.pone.0241605. eCollection 2020.
This study aimed to examine patterns and determinants of modern contraceptive discontinuation among women in Kenya.
Secondary analysis was conducted using national representative Kenya Demographic and Health Surveys of 2003, 2008/9, and 2014. These household cross-sectional surveys targeted women of reproductive age from 15 to 49 years who had experienced an episode of modern contraceptive use within five years preceding the surveys from 2003 (n = 2686), 2008/9 (n = 2992), and 2014 (5919). The contraceptive discontinuation rate was defined as the number of episodes discontinued divided by the total number of episodes. Weighted descriptive statistics, multivariable logistic regression analysis, and Cox proportional hazards analysis were used to examine the determinants of contraceptive discontinuation.
The 12-month contraceptive discontinuation rate for all methods declined from 37.5% in 2003 and 36.7% in 2008/9 to 30.5% in 2014. Consistently across the three surveys, intrauterine devices had the lowest 12-month discontinuation rate (6.4% in 2014) followed by implants (8.0%, in 2014). In 2014, higher rates were seen for pills (44.9%) and male condoms (42.9%). The determinants of contraceptive discontinuation among women of reproductive age in the 2003 survey included users of short-term contraception methods, specifically for those who used male condoms (hazard ratio [HR] = 3.30, 95% confidence interval [CI] = 2.13-5.11) and pills (HR = 2.68; 95CI = 1.79-4.00); and younger women aged 15-19 year (HR = 2.07; 95% CI = 1.49-2.87) and 20-24 years (HR = 1.94; 95% CI = 1.61-2.35). The trends in the most common reasons for discontinuation from 2003 to 2014 revealed an increase among those reporting side effects (p = 0.0002) and those wanting a more effective method (p<0.0001). A decrease was noted among those indicating method failure (p<0.0001) and husband disapproval (p<0.0001).
Family planning programs should focus on improving service quality to strengthen the continuation of contraceptive use among those in need. Women should be informed about potential side effects and reassured on health concerns, including being provided options for method switching. The health system should avail a wider range of contraceptive methods and ensure a constant supply of commodities for women to choose from. Short-term contraceptive method users and younger women may need greater support for continued use.
本研究旨在探讨肯尼亚女性现代避孕方法中断的模式和决定因素。
使用 2003 年、2008/9 年和 2014 年肯尼亚全国具有代表性的人口与健康调查的二次分析数据。这些家庭横断面调查针对的是 15 至 49 岁的育龄妇女，她们在调查前五年内经历过现代避孕方法的使用，2003 年（n=2686）、2008/9 年（n=2992）和 2014 年（n=5919）。避孕方法的中断率定义为中断的周期数与总周期数的比值。使用加权描述性统计、多变量逻辑回归分析和 Cox 比例风险分析来检查避孕方法中断的决定因素。
所有方法的 12 个月避孕方法中断率从 2003 年的 37.5%和 2008/9 年的 36.7%下降到 2014 年的 30.5%。在这三次调查中，宫内节育器的 12 个月中断率始终最低（2014 年为 6.4%），其次是植入物（2014 年为 8.0%）。2014 年，避孕药（44.9%）和男用避孕套（42.9%）的使用率较高。2003 年调查中，育龄妇女避孕方法中断的决定因素包括短期避孕方法的使用者，特别是使用男用避孕套（风险比[HR] = 3.30，95%置信区间[CI] = 2.13-5.11）和避孕药（HR = 2.68；95CI = 1.79-4.00）；以及年龄在 15-19 岁（HR = 2.07；95% CI = 1.49-2.87）和 20-24 岁（HR = 1.94；95% CI = 1.61-2.35）的年轻女性。2003 年至 2014 年期间，最常见的中断原因趋势显示，报告副作用的人数有所增加（p=0.0002），以及希望使用更有效的方法的人数有所增加（p<0.0001）。报告方法失败（p<0.0001）和丈夫反对（p<0.0001）的人数有所减少。
计划生育项目应注重提高服务质量，加强有需要的人群对避孕方法的持续使用。应告知妇女潜在的副作用，并解决她们的健康问题，包括提供方法转换的选择。卫生系统应提供更广泛的避孕方法，并确保妇女有持续的商品供应可供选择。短期避孕方法使用者和年轻妇女可能需要更多的支持来继续使用。
