Determinants Impacting the Adoption of Long-Acting Contraception among Women in Fort Portal Regional Referral Hospital’s MCH Clinic
Haruna Yakasai Abubakar
Department of Medicine and Surgery, Kampala International University, Uganda
ABSTRACT
Unintended pregnancies pose significant global public health concerns, impacting individuals, families, and society at large. Despite their efficacy, the utilization of long-acting contraceptive methods (LACMs) has lagged behind short-acting methods like oral contraceptives and injections, and the reasons for this disparity remain unclear. This study aimed to assess the level of LACM utilization among women attending the MCH clinic at Fort Portal Regional Referral Hospital (FRRH) and to identify potential influencing factors. Using a descriptive cross-sectional design, data was collected from 52 respondents through a pretested questionnaire. Analysis conducted using IBM SPSS 25.0 revealed a mean respondent age of 27.6±4.8 (SD) years, with a LACM prevalence of 26.9%. Factors associated with LACM use included maternal age ≥30 years and having four or more children (X2=11.47; p=0.001) and (X2=37.66; P=<0.001) respectively. The prevalence of LACM use among women at FRRH’s MCH clinic was notably lower (26.9%) compared to short-acting contraceptive methods (73.1%). Notably, this study highlighted maternal age ≥30 years and parity ≥4 as significant factors linked with LACM utilization. Recommendations stemming from this study advocate for strategies devised by healthcare providers and stakeholders aimed at increasing LACM utilization, particularly among women under thirty years old and those with a parity of three or less. Additionally, further research is suggested to delve deeper into the reasons behind this low prevalence, fostering a more comprehensive understanding of the underlying factors influencing contraceptive choices among this demographic.
Keywords: risk factors, contraceptive, women
INTRODUCTION
Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is achieved through use of modern contraceptive methods and the treatment of infertility (World Health Organization) [1]. Modern contraceptives methods are divided into three: – Long-acting reversible contraceptive methods (IUCD & Implants); permanent contraceptive methods (tubal ligation & vasectomy) and short-term contraceptives methods (Oral pill, inject-able, male& female condoms, foam tablet &cervical cap [2, 3]. Because of their long-lasting protection and reversibility, the reversible long-term contraceptive is an effective contraceptive method appropriate for women wishing to limit child bearing, as well as to space births, thus potentially playing an enormous role in reducing maternal mortality [4].
Globally, 214 million women of reproductive age in developing countries who want to avoid pregnancy are not using a modern contraceptive method [5]. This unmet need for contraception is too high and variation in different regions is observed [1]. This inequity is fueled by both a growing population, and a shortage of family planning services. In Africa, 24.2% of women of reproductive age have an unmet need for modern contraception. In Asia, and Latin America and the Caribbean – regions with relatively high contraceptive prevalence – the levels of unmet need for family planning are 10.2 % and 10.7%, respectively [6].
Unintended pregnancy remains an alarming global public health problem with its subsequent socioeconomic impact on individuals, families, and the society [7]. Though there is a considerable variation in the prevalence of unintended pregnancy across regions, the global burden is very high (44% in 2014) [8] and responsible for 27% of maternal deaths [9]. Different cross-sectional studies around the globe noted that there has been a high prevalence of unintended pregnancy for example, 69% in Malawi [10], 27% in Canada [11] and 44% in Botswana [9] highlighting the need for effective contraceptive utilization [9]. The 2016 Uganda Demographic and Health Survey (UDHS) report showed that there was 28% and 32% of unmet need for family planning among married and unmarried sexually active women respectively [12]. Evidence suggests that women who have more than 4 children are at increased risk of maternal mortality [13]. By reducing rates of unintended pregnancies, family planning also reduces the need for unsafe abortion [14].
The Uganda ministry of health and private partners’ campaigns for the use of long-acting contraceptive method, however, the contraceptive method mix is dominated by short term methods like pills and Injectables [15]. There are no studies that have examined the factors contributing to long-acting contraception methods utilization on the study area. The present study was intended to contribute to bridging information gap about and subsequently the coverage of long-acting contraceptive method utilization in the local setting.
A cross-sectional study design was used [16].
The study was conducted in MCH clinic in Fort Portal Regional Referral Hospital.
The study involved women attending MCH clinic.
- women who are 18-49 years old
- Willing to participate
- Not willing to participate in the survey
- Below 18 years and above 49 years
The sample size was determined by using Kish’s formula [17].
The study used consecutive sampling where each woman that comes and agrees to participate was enrolled.
This study used a questionnaire to collect data from the respondents.
Collected data was entered and analyzed using IBM SPSS version 25.0 Categorical variables were presented in a table of frequencies for descriptive statistics. A Chi-square test was computed to test the factors influencing utilization of LACMs. The point for statistical implication was p-values of ≤0.05.
Ethical approval was sought from Kampala international university western campus Faculty of clinical medicine and dentistry in form of introduction letter after approval of the proposal. A written and verbal consent was sought from the respondents before they participated in the study [18].
RESULTS
The mean age of the respondents was 27.6±4.8 (SD) years. More than half (65.4%) were aged ≤29 years, 57.7% were house wives and only 19.2% had tertiary education. Table 1.
Table 1: Demographic characteristics of respondents
| Variables | Frequency | Percent | |
| Age group | ≤29 | 34 | 65.4 |
| ≥30 | 18 | 34.6 | |
| Total | 52 | 100.0 | |
| Occupation | House wife | 30 | 57.7 |
| Business | 11 | 21.2 | |
| Employed | 11 | 21.2 | |
| Total | 52 | 100.0 | |
| Religion | Catholic | 20 | 38.5 |
| Protestant | 10 | 19.2 | |
| Muslim | 7 | 13.5 | |
| Pentecostal | 15 | 28.8 | |
| Total | 52 | 100.0 | |
| Education level | Non | 10 | 19.2 |
| Primary | 20 | 38.5 | |
| Secondary | 12 | 23.1 | |
| Tertiary | 10 | 19.2 | |
| Total | 52 | 100.0 | |
| Parity | ≤3 | 39 | 75.0 |
| ≥4 | 13 | 25.0 | |
| Total | 52 | 100.0 | |
Table 2: Relationship between demographic characteristics and use of LACM
| Variables | LACM | Total | Chi square | P value | ||
| No | Yes | (X2) | ||||
| Age group | <29 | 30 | 4 | 34 | ||
| 88.2% | 11.8% | 100.0% | 11.47 | 0.001 | ||
| >30 | 8 | 10 | 18 | |||
| 44.4% | 55.6% | 100.0% | ||||
| Occupation | House wife | 23 | 7 | 30 | ||
| 76.7% | 23.3% | 100.0% | ||||
| Business | 8 | 3 | 11 | 0.69 | 0.706 | |
| 72.7% | 27.3% | 100.0% | ||||
| Employed | 7 | 4 | 11 | |||
| 63.6% | 36.4% | 100.0% | ||||
| Religion | Catholic | 14 | 6 | 20 | ||
| 70.0% | 30.0% | 100.0% | ||||
| Protestant | 8 | 2 | 10 | |||
| 80.0% | 20.0% | 100.0% | 0.35 | 0.950 | ||
| Muslim | 5 | 2 | 7 | |||
| 71.4% | 28.6% | 100.0% | ||||
| Pentecostal | 11 | 4 | 15 | |||
| 73.3% | 26.7% | 100.0% | ||||
| Education level
|
Non | 7 | 3 | 10 | ||
| 70.0% | 30.0% | 100.0% | ||||
| Primary | 15 | 5 | 20 | |||
| 75.0% | 25.0% | 100.0% | ||||
| Secondary | 9 | 3 | 12 | 0.16 | 0.984 | |
| 75.0% | 25.0% | 100.0% | ||||
| Tertiary | 7 | 3 | 10 | |||
| 70.0% | 30.0% | 100.0% |
|
|||
The results show that current number of children the woman have is statistically significant (X2=37.66; P=<0.001).
Table 3: Relationship of LACM use and current number of children
| Variables | LACM | Total | Chi square | P value | ||
| No | Yes | (X2) | ||||
| Current number of children | ≤3 | 37 | 2 | 39 | ||
| 94.9% | 5.1% | 100.0% | ||||
| ≥4 | 1 | 12 | 13 | 37.66 | <0.001 | |
| 7.7% | 92.3% | 100.0% | ||||
| Total | 38 | 14 | 52 | |||
| 73.1% | 26.9% | 100.0% | ||||
Discussion with partner about FP was not found to be statistically significant (X2=0.01; p=0.977).
Table 4: Relationship of LACM use and discussion of FP with partner
| Variable | LACM | Total | Chi square | P value | ||
| No | Yes | (X2) | ||||
| Discussion with partner about FP | No | 8 | 3 | 11 | ||
| 72.7% | 27.3% | 100.0% | ||||
| Yes | 30 | 11 | 41 | 0.01 | 0.977 | |
| 73.2% | 26.8% | 100.0% | ||||
| Total | 38 | 14 | 52 | |||
| 73.1% | 26.9% | 100.0% | ||||
In this study, the prevalence of long-acting contraceptive use was 26.9%. The prevalence of contraceptive use among women in this study is comparable to that of the general women population in Uganda (26.9% versus 30%) [19]. The contraceptive prevalence in this study is also consistent with earlier studies reporting contraceptive use of 22.3% in Uganda [20] and a prevalence of 29% in a Kenyan hospital [21]. The similarity could be attributed to similar social economic characteristics of the participants.
The variables which were found significant were; mother’s age (X2=11.47; p=0.001) and current number of children (X2=37.66; P=<0.001). Age and number of children has been reported by other studies to influence use of contraception in Ethiopia, Cameron, Uganda and Rwanda [22, 23, 15, 24] respectively. In this study, it is noted that age specific LACM prevalence rate increase with age of women. Majority of women who were using LACM were ≥30 years (71.4%) compared to those ≤29 years old. This may be attributed to many reasons; firstly, age is associated with experience in child birth which may come with access to health education about contraception. Secondly, old age may be associated with increasing needs from large family which puts economic pressure thus need to limit or control child birth.
Like with this study, there is consensus from other studies [25, 13, 5] that LACM use is more likely among women with higher number of children. This study found that a large percentage (92.3%) of women who had ≥4 children were using LACM compared to only 5.1% of those that had ≤3 children. Also, many women reject contraception because bearing and raising children is the path to respect and dignity [23]. As aforementioned, a high number of children comes with a cost, not only for feeding but also healthcare and education. The driving force towards use of LACM in older women and those with large number of children could be due to the desire for limiting the number of children in the face of an advancing age. The reproductive health implication of these findings suggests a targeted intervention such as health education and patient-specific counselling to create awareness on the benefits of LACM. Unlike other studies which showed that the factors that determine LACM use among women included higher education [13], employment status [4], and discussion of family planning with a partner [26], this study found these factors not significant.
The prevalence of LACM use among women attending MCH clinic at FRRH was low (26.9%) as compared to short acting contaceptive methods (73.1%), and is significantly associated with age above thirty (30) and parity equal to or greater than 4.
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CITE AS: Haruna Yakasai Abubakar (2023). Determinants Impacting the Adoption of Long-Acting Contraception among Women in Fort Portal Regional Referral Hospital’s MCH Clinic. IAA Journal of Applied Sciences 10(1):122-129. https://doi.org/10.59298/IAAJAS/2023/10.1.1000.