Sarnak Dana O, Gummerson Elizabeth, Wood Shannon N, OlaOlorun Funmilola M, Kibira Simon Peter Sebina, Zimmerman Linnea A, Anglewicz Philip
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria.
Contracept X. 2022 May 6;4:100077. doi: 10.1016/j.conx.2022.100077. eCollection 2022.
A more nuanced understanding of contributors to covert contraceptive use remains critical to protecting covert users and reducing its necessity. This study aimed to examine the overall prevalence of covert use, and sociodemographic characteristics associated with covert vs overt use across multiple geographies in sub-Saharan Africa and Asia.
Performance Monitoring for Action (PMA) is one of the few nationally representative surveys that measures covert use across socially diverse contexts via a direct question. Utilizing PMA 2019-2020 phase 1 data from Burkina Faso, Côte D'Ivoire, Kenya, Democratic Republic of Congo (DRC; Kinshasa and Kongo Central regions), Uganda, Nigeria (Kano and Lagos), Niger, and Rajasthan, we estimated overall prevalence of covert use. We conducted bivariate analyses and multivariate logistic regressions for 6 sites, comparing the odds of covert use with overt use among users of contraception by sociodemographic characteristics.
Covert use ranged from 1% in Rajasthan to 16% in Burkina Faso. Marital status was the only sociodemographic characteristic consistently associated with type of use across sites. Specifically, polygynous marriage (compared to monogamous) increased odds of using covertly, ranging from adjusted odds ratio (aOR) of 1.8 [95% confidence interval (CI) 1.2-2.7] in Burkina Faso to 6.2 [95% CI 2.9-13.3] in Kinshasa. Unmarried women with partners or boyfriends were also more likely to be using covertly compared with their monogamously married counterparts in all sites (aORs ranged from 2.2 [95% CI 1.0-4.7] in Uganda to 4.4 [95% CI 1.7-11.0] in Kinshasa).
Understanding factors associated with covert use has programmatic and policy implications for women's reproductive autonomy.
Covert use is a common phenomenon across most sites, representing a small but programmatically important contingent of users. Family planning providers and programs must protect access to and maintain privacy of reproductive services to this population, but should also focus on creating interventions and environments that support overt use.
更细致地了解隐蔽使用避孕药具的影响因素对于保护隐蔽使用者并减少这种需求至关重要。本研究旨在调查撒哈拉以南非洲和亚洲多个地区隐蔽使用避孕药具的总体流行率，以及与隐蔽使用和公开使用相关的社会人口学特征。
行动绩效监测（PMA）是少数几个具有全国代表性的调查之一，通过直接提问来衡量不同社会背景下的隐蔽使用情况。利用来自布基纳法索、科特迪瓦、肯尼亚、刚果民主共和国（金沙萨和刚果中部地区）、乌干达、尼日利亚（卡诺和拉各斯）、尼日尔和拉贾斯坦邦的2019 - 2020年第一阶段PMA数据，我们估计了隐蔽使用的总体流行率。我们对6个地点进行了双变量分析和多变量逻辑回归，按社会人口学特征比较了避孕药具使用者中隐蔽使用与公开使用的几率。
隐蔽使用的比例从拉贾斯坦邦的1%到布基纳法索的16%不等。婚姻状况是唯一一个在所有地点都始终与使用类型相关的社会人口学特征。具体而言，一夫多妻制婚姻（与一夫一妻制相比）增加了隐蔽使用的几率，从布基纳法索的调整优势比（aOR）1.8[95%置信区间（CI）1.2 - 2.7]到金沙萨的6.2[95% CI 2.9 - 13.3]。在所有地点，有伴侣或男朋友的未婚女性与一夫一妻制婚姻的女性相比，也更有可能隐蔽使用（aOR范围从乌干达的2.2[95% CI 1.0 - 4.7]到金沙萨的4.4[95% CI 1.7 - 11.0]）。
了解与隐蔽使用相关的因素对妇女的生殖自主权具有规划和政策意义。
隐蔽使用在大多数地点是一种常见现象，代表了一小部分但在规划上具有重要意义的使用者群体。计划生育提供者和项目必须保护这部分人群获得生殖服务的机会并维护其隐私，但也应专注于创造支持公开使用的干预措施和环境。
