Sarnak Dana O, Tsui Amy, Makumbi Fredrick, Kibira Simon Peter Sebina, Ahmed Saifuddin
Population, Family and Reproductive Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Epidemiology and Biostatistics Department, School of Public Health, Makerere University, Kampala, Uganda.
Demography. 2021 Feb 1;58(1):295-320. doi: 10.1215/00703370-8937285.
Although many studies have examined the influence of women's fertility preferences on subsequent fertility behavior and the role of contraceptive use intentions on unmet need, very few have explored their concurrent effects on contraceptive use dynamics. This study examines the independent concurrent effects of women's fertility preferences and contraceptive intentions on subsequent adoption and discontinuation, treating pregnancy as a competing risk factor that may alter contraceptive need. The data are derived from a 2018 follow-up survey of a 2014 national sample of 3,800 Ugandan female respondents of childbearing age. The survey included a contraceptive calendar that recorded pregnancy, birth, and contraceptive event episodes, including reasons for discontinuation. We use competing risk regression to estimate the effect of fertility preferences and contraceptive intentions on the cumulative incidence function of contraceptive behaviors, accounting for intervening pregnancy, female background covariates, loss to follow-up, and complex survey design. We find that women's contraceptive intentions significantly increase the rate of contraceptive adoption. After having adopted, women's contraceptive intentions have been realized and do not prolong use. The risk of discontinuation among women who adopted after baseline was significantly higher than for those using at baseline, irrespective of their initial intentions. The effectiveness of the type of contraceptive method chosen significantly lowered discontinuation risk. Fertility preferences were not significantly associated with either time to adoption or discontinuation. The pace of the fertility transition in this sub-Saharan African setting is likely being shaped by reproductive regulation through the intentional use of contraception that enables spacing births.
尽管许多研究考察了女性生育偏好对后续生育行为的影响以及避孕使用意图对未满足需求的作用，但很少有研究探讨它们对避孕使用动态的共同影响。本研究考察了女性生育偏好和避孕意图对后续采用和停用避孕措施的独立共同影响，将怀孕视为可能改变避孕需求的竞争风险因素。数据来源于对2014年全国3800名乌干达育龄女性受访者样本的2018年随访调查。该调查包括一个避孕日历，记录了怀孕、生育和避孕事件情节，包括停用原因。我们使用竞争风险回归来估计生育偏好和避孕意图对避孕行为累积发生率函数的影响，同时考虑到中间的怀孕情况、女性背景协变量、随访失访以及复杂的调查设计。我们发现，女性的避孕意图显著提高了避孕措施的采用率。采用避孕措施后，女性的避孕意图得以实现，并不会延长使用时间。基线后采用避孕措施的女性停用的风险显著高于基线时就使用避孕措施的女性，无论她们最初的意图如何。所选择的避孕方法类型的有效性显著降低了停用风险。生育偏好与采用或停用避孕措施的时间均无显著关联。在撒哈拉以南非洲地区，生育转变的速度可能受到通过有意使用避孕措施来调节生育的影响，这种措施能够实现生育间隔。
