Coulibaly Abou, Baguiya Adama, Kpebo Denise, Zango Augustin, Tougri Halima, Garanet Franck, Kouanda Seni
Département Biomédical et Santé Publique, Institut de Recherche en Sciences de La Santé (IRSS), 03 BP 7047, Ouagadougou, Burkina Faso.
Institut Africain de Santé Publique (IASP), 12 BP 199, Ouagadougou, Burkina Faso.
Arch Public Health. 2025 Jan 20;83(1):16. doi: 10.1186/s13690-025-01506-6.
Contraception discontinuation is a concern, especially if it occurs in breastfeeding women, thereby exposing them to a high risk of close and unwanted pregnancies. Our study aimed to measure the prevalence and identify the individual and community-level factors associated with the discontinuation of modern contraceptives among breastfeeding women.
This was a secondary analysis of retrospective data of the most recent Demographic and Health Surveys (DHS) data from nine high-fertility rate countries, conducted mostly between 2018-2021. We reported weighted frequencies of modern contraceptives discontinuation (binary variable, coded 1 and 0). The independent variables included individual-level variables, including sociodemographic characteristics, female reproduction and family planning history, the women and their households exposure to media, and community-level ones such as place of residence (urban and rural) and country. Multilevel-modified Poisson regression was used to identify associated factors at the 5% threshold.
The overall prevalence of modern contraceptives discontinuation was 13.1% among 5,599 lactating mothers, with wide variations between countries (prevalence ranging from 8.2% in Sierra Leone to 33.6% in Guinea). Women were more likely to discontinue contraception if they were the head of the household (adjusted prevalence ratio (aPR) = 1.71; 95% CI [1.17-2.50]; p = 0.006). In addition, compared to implant users, women using pills (aPR = 3.06; 95% CI [2.24-4.16]; p < 0.001), those using injectables (aPR = 2.80; 95% CI [2.16-3.62]; p < 0.001), and women whose partners used condoms (aPR = 2.30; 95% CI [1.47-3.59]; p < 0.001) were more likely to discontinue contraception. Moreover, women who were not sexually active (aPR = 2.11; 95% CI [1.75-2.54]; p < 0.001) and those who wanted children within two subsequent years (aPR = 1.84; 95% CI [1.36-2.48]; p < 0.001) were more likely to discontinue contraception. Finally, method discontinuation varied by country, with women in Gambia, Guinea, Mauritania, and Mali more likely to discontinue a modern contraceptive method than those living in Burkina Faso.
To improve the retention of women using contraceptive, high-fertility rate countries need to focus on contraceptive education, communication about side effects, dissemination of family planning messages through the media, and regular monitoring of women taking contraceptives.
避孕措施的中断令人担忧，尤其是发生在哺乳期妇女身上时，这会使她们面临意外怀孕的高风险。我们的研究旨在衡量现代避孕措施在哺乳期妇女中的中断率，并确定与之相关的个人和社区层面因素。
这是对九个高生育率国家最近的人口与健康调查（DHS）回顾性数据的二次分析，这些数据大多收集于2018年至2021年期间。我们报告了现代避孕措施中断的加权频率（二元变量，编码为1和0）。自变量包括个人层面的变量，如社会人口特征、女性生殖和计划生育史、妇女及其家庭接触媒体的情况，以及社区层面的变量，如居住地点（城市和农村）和国家。采用多水平修正泊松回归分析来确定5%显著性水平下的相关因素。
在5599名哺乳期母亲中，现代避孕措施的总体中断率为13.1%，各国之间存在很大差异（中断率从塞拉利昂的8.2%到几内亚的33.6%不等）。如果女性是户主，则更有可能停止避孕（调整患病率比（aPR）=1.71；95%置信区间[1.17 - 2.50]；p = 0.006）。此外，与使用植入式避孕法的女性相比，使用口服避孕药的女性（aPR = 3.06；95%置信区间[2.24 - 4.16]；p < 0.001）、使用注射式避孕法的女性（aPR = 2.80；95%置信区间[2.16 - 3.62]；p < 0.001）以及伴侣使用避孕套的女性（aPR = 2.30；95%置信区间[1.47 - 3.59]；p < 0.001）更有可能停止避孕。此外，无性活动的女性（aPR = 2.11；95%置信区间[1.75 - 2.54]；p < 0.001）以及希望在随后两年内生育子女的女性（aPR = 1.84；95%置信区间[1.36 - 2.48]；p < 0.001）更有可能停止避孕。最后，避孕措施的中断情况因国家而异，冈比亚、几内亚、毛里塔尼亚和马里的女性比布基纳法索的女性更有可能停止使用现代避孕方法。
为提高使用避孕措施的女性的留存率，高生育率国家需要关注避孕教育、副作用的宣传、通过媒体传播计划生育信息以及对服用避孕药的女性进行定期监测。
