203917 Why women discontinue using contraceptive injectables in Nyando District Kenya: Social, medical and logistical reasons

Monday, November 9, 2009

Holly McClain Burke, MPH , Behavioral and Biomedical Research, Family Health International, Research Triangle Park, NC
Constance Ambasa-Shisanya, PhD , Family Health International, Nairobi, Kenya
BACKGROUND: Discontinuation of contraception is a major problem in Kenya. Almost a fifth of women abandon their contraceptives within 12 months of beginning use, despite still being in need. In an effort to identify target groups and appropriate messages for a communication campaign to increase contraceptive continuation, focus group discussion (FGDs) were conducted in Nyando District, Kenya.

METHODS: Four FGDs were conducted with current contraceptive injectable users recruited from Ministry of Health Family Planning (FP) clinics to determine why women discontinue using contraceptives (with a focus on injectables) and identify their salient references—people who influence women's use and discontinuation of contraception. FGD data from current users were analyzed and five salient reference groups identified for a second round of FGDs. Then two FGDs were conducted with each of the groups: husbands, mothers-in-law, community leaders, service providers and long-term contraceptive injectable users. Data analysis was performed using NVivo 7 software.

RESULTS: Discontinuation of contraceptive use in Nyando District occurs either through direct decisions of current users or through the influence of salient reference groups. Women in this community do not always have control over the use and continued use of contraception. Common reasons for discontinuation include side effects, husbands' opposition, mothers-in-law' opposition, myths, stock outs, and lack of cash to purchase contraceptives or pay for FP services. Current users and reference groups had a low level of knowledge regarding side effects of contraceptives, especially injectables. Consequently, lack of adequate knowledge about injectables was found as a key factor in discontinuation.

Learning Objectives:
1. Discuss five key reasons women in Nyando District Kenya discontinue use of contraceptive injectables while still in need of family planning. 2. Identify areas of intervention for increasing continuation among current contraceptive injectable users in a resource-poor setting.

Keywords: International Family Planning, Adherence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principle investigator of the study which generated the data for this presentation. In this role I am responsible for the design, management and scientific quality of the study. I analyzed the data for this presentation in conjunction with the co-author. I have worked as a researcher at Family Health International for seven years conducting reproductive health research in developing countries. I hold a Master of Public Health degree from the University of North Carolina at Chapel Hill (UNC-CH), Department of Health Behavior and Health Education. I am currently working on my PhD dissertation in the Department of Maternal and Child Health at UNC-CH.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.