Contraceptive Trends Among Women at Reproductive Age in Cambodia, from 2007 to 2009

Background: Cambodia's low contraceptive prevalence rate (CPR) of 27% contributes to a very high maternal mortality rate (472 per 100000) (2005 CDHS). PSI/Cambodia aims to increase use of high quality affordable reproductive health products and services. To monitor the impact of PSI‘s programs, a longitudinal behavioral survey was conducted in 2007 and 2009. Methods: The study population were women in two provinces, aged 15-49, sexually active (last 12 months); not currently pregnant; and not intending to have a child in next 2 years. Using a stratified multi-stage design a sample of 704 (2007) and 859 (2009) women were selected.

Results: The CPR was 39.7% in 2009 and 42.7% in 2007, showing no significant change. However, the data reveal a significant increase in the proportion of women who have ever used a modern birth spacing method from 60.8% to 65.9% (p<0.001). The rate of discontinuation has also increased significantly from 54.5% to 65.4% (p<0.001). The proportion of women who reported side effects as the main reason for discontinuation nearly doubled (26.2% to 44.9%, p<.001), while the proportion of women who discontinued because they wanted more children fell significantly from 52.2% to 31.1% (p<.001). Conclusions: These data indicate that more women are using modern birth spacing methods but that a higher proportion is also giving up on use. Greater programmatic focus on reducing discontinuity rates is needed. Programs should address the real and perceived side effects and ensure opportunities to switch methods- particularly from hormonal methods to non-hormonal methods such as IUDs.