Archives of International Surgery

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 8  |  Issue : 3  |  Page : 108--112

Reasons for contraceptive discontinuation at Ahmadu Bello University Teaching Hospital Zaria, Northern Nigeria


Hauwa Shuaib Umar, Hajaratu Umar 
 Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital Zaria, Kaduna, Nigeria

Correspondence Address:
Dr. Hauwa Shuaib Umar
Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital Zaria, Kaduna
Nigeria

Abstract

Background: Despite the low uptake of contraceptive methods in Nigeria and the associated obstetric and medical complications of high birth rate, some of the clients still find reason to discontinue the methods. To determine the reasons for discontinuation of contraceptive methods among clients at the Ahmadu Bello University Teaching Hospital, Shika-Zaria. Patients and Methods: A descriptive cross-sectional study of clients attending the reproductive health clinic of Ahmadu Bello University Teaching Hospital, Zaria, from January to June 2013. Structured questionnaires were administered to consented clients. Information obtained included the following: sociodemographic data, gynecological history, history of contraception, and reasons for discontinuing a contraceptive method. Data were analyzed using Minitab version 15. Results: Majority of the respondents were multiparous, within the age group of 20–29 years, with tertiary education and civil servants. Most of the respondents, 161 (53.3%), had used a contraceptive method before, mostly injectables 64 (40%). In total, 100 clients (62.5%) were still on their methods of choice, whereas 61 (37.8%) had discontinued, giving a discontinuation rate of 37.9%. Majority, 26 (42.6%) discontinued due to reduced need for the method (mostly to conceive), whereas 22 (36.1%) discontinued due to method problems (mostly menstrual problems). Others had no known reason 6 (9.8%), not interested 6 (9.8), and 1 (1.6%) had failure of the method. Clients aged 30–34 years and only Quranic education were more likely to have unmet need for contraceptive use. Conclusion: There is need for effective counseling, education on side effects, and health concerns regarding modern contraceptive methods.



How to cite this article:
Umar HS, Umar H. Reasons for contraceptive discontinuation at Ahmadu Bello University Teaching Hospital Zaria, Northern Nigeria.Arch Int Surg 2018;8:108-112


How to cite this URL:
Umar HS, Umar H. Reasons for contraceptive discontinuation at Ahmadu Bello University Teaching Hospital Zaria, Northern Nigeria. Arch Int Surg [serial online] 2018 [cited 2019 Dec 15 ];8:108-112
Available from: http://www.archintsurg.org/text.asp?2018/8/3/108/268129


Full Text



 Introduction



Despite the introduction of family planning services in Nigeria, the total fertility rate has remain high with slight decline from 5.7 to 5.5 in 2008 and 2013, respectively, according to the NDHS (National Demographic Health Survey).[1] The North Western part of Nigeria has the highest value of 6.7%, whereas the South-South has the lowest value of 4.3%. The appropriate uptake of modern contraceptives for limiting or spacing births is a priority for improving women's health and reducing maternal morbidity and mortality. The prevalence of contraceptive use in Nigeria is low, with only 15% of married women of reproductive age using any method, whereas only 10% use modern methods.[1] Modern contraceptive usage is highest in the South West with a value of 38% and lowest in North West and North East with only 3% and 4%, respectively.[1] Hence, the global family planning aims at achieving up to 120 million additional women and adolescents on family planning services by 2020.[2]

Some of the limitations to modern contraceptive use in some developing countries like Nigeria includes lack of knowledge, obstacles to access and concern over side effects, and association with promiscuity and diseases.[3] It was reported that 38% of women with a desire to delay or avoid pregnancy but are not using any modern method of family planning (unmet need for modern contraceptives) were on a method prior to discontinuation as a result of one reason or the other.[4] Thus, contraceptive discontinuation refers to stopping a contraceptive use due to any reason, while still at the risk of an unintended pregnancy.[5] Also, 33% of unintended birth has been associated with discontinuation of a contraceptive method.[6] All-method discontinuation rate to of 38% within the first year of use and 55% by the second year has been reported from a comprehensive analysis of Demographic Health Survey (DHS) data from 25 countries.[7] Hence, with the low contraceptive prevalence rate, the high unmet need for contraceptive use, and the high discontinuation rates, this study aimed to know the reasons for discontinuing a modern contraceptive method especially in Northern Nigeria using the Reproductive Health Clinic of Ahmadu Bello University Teaching Hospital, Zaria, as a case study.

 Patients and Methods



Study setting

The Reproductive Health Clinic of Ahmadu Bello University Teaching Hospital (ABUTH) serves as a tertiary center that caters for the family planning services for clients within Zaria, Kaduna state and Northern Nigeria, in general.

Study design and population

A cross-sectional descriptive study carried out from January to June 2013 to determine the reasons for discontinuing a contraceptive method among clients attending the Reproductive Health Clinic of ABUTH. The study included all consented women of reproductive age group (15–49 years) seeking for family planning services at the clinic.

Sample size determination and sampling technique

The minimum sample size was 216 after correction for attrition rate, using the formula below:[8]

n = zᾳ2pq/d2

where zᾳ2 is the standard normal deviate = 1.96, p is prevalence of all methods of contraceptive use in Nigeria = 0.151, and d = 0.05.

Convenience sampling technique was employed to select the clients for this study.

Data collection tool and procedure

A pretested, structured interview-administered questionnaire was administered to 310 consented clients. In total, 302 questionnaires were completely filled with the necessary data giving a response rate of 95.6%. The data collection was conducted by the researcher and trained research assistants (three nurses from the reproductive health clinic). The questionnaires were reviewed during and after data collection for completeness and relevance by the researcher. The questionnaire sought information regarding sociodemographic characteristics, contraceptive history, and reasons for discontinuing a contraceptive method within the first 12 months of use.

Data processing and analysis

Data collected were recorded using Microsoft Excel and transferred to Minitab version 15 for analysis. The descriptive analysis was done using frequency distribution tables and percentages. The status of clients after contraceptive discontinuation was expressed as odds ratios and confidence intervals from Binary Logistic Regression. Statistical significance was said to be obtained at a P value < 0.05.

 Results



Among the 302 clients who were interviewed, majority 161 (53.3%) had used a contraceptive method before, whereas 141 had not. Among the 161 clients who had used contraceptive in the past, more than half (65.3%) were within the age of 20 and 29 years, multiparous (52.8%), and Muslims (53.4%) with tertiary education (66.5%). Majority were Hausa (38.0%) as shown in [Table 1].{Table 1}

The contraceptives used by the clients were mainly injectables, 64 (40%; Depo, Noristerate and Injectable), followed by natural methods, 35 (22%; plus cycle beads and withdrawal). Others include daily oral pills, 23 (14%); subdermal implants, 19 (12%); intrauterine copper T, 11 (7%); condoms, 7 (4%); and postinor 2 (1%) as shown in [Figure 1].{Figure 1}

Among the 161 clients who had used a contraceptive method in the past, 100 (62.5%), were still on their methods of choice, whereas 61 (37.8%) had discontinued, giving a discontinuation rate of 37.9%. Majority of clients 26 (42.6%) discontinued due to reduced need for the method (mostly to conceive), whereas 22 (36.1%) discontinued the method because of method problems (mostly menstrual problems). Others had no known reason 6 (9.8%), were not interested 6 (9.8), and only 1 (1.6%) had failure of the method [Table 2].{Table 2}

In total, 32 clients (53%) did not intend to switch to another method of contraceptive after discontinuation based on the reasons they gave (method problems, unknown reason, and not interested), while 2 clients (3%) discontinued in order to switch to another method. The 27 clients [44%; who wanted to conceive (26 clients) or became pregnant due to the failure of the method (1 client)] had “no need” for another method as they wish to conceive or became pregnant, respectively.

[Table 3] shows the status of the clients as odds ratios from binary logistics regression of the likelihood of being in “no need” relative to “in need” of a contraceptive method after discontinuation of a method. The clients in the age group 30–34 years were 96% significantly less likely to be in a state of “no need” of a contraceptive relative to being “in need” of one after discontinuation compared with the other age group. Similarly, clients with Quranic education had lowest odds of being in “no need” compared with those with primary, secondary, or tertiary education. Religion, tribe, and parity of the clients showed less likelihood to be in “no need” relative to be “in need” in various degrees but were not statistically significant.{Table 3}

 Discussion



Among the clients interviewed 302, only half (53.3%) had used a contraceptive method, and about a quarter had discontinued use (37.8%). The contraceptive uptake in Nigeria and especially in the Northern region had remained low over the years despite more awareness about contraceptive knowledge among women.[1],[9],[10],[11] The low contraceptive uptake had been associated with risk of unwanted pregnancies and adverse effect to maternal and infant health. Majority of the clients were within the reproductive age group of 20–29 years, which was similarly reported from multicenter studies in Nigeria.[12] Similar to a previous Zaria study, most of the clients were educated, Hausa, and Muslims.[13] This is not surprising as majority of the clients in this study were civil servants and from the same study settings. The level of education of the majority of the clients was to tertiary level, which was similarly reported in a Southern Nigerian study.[14] The clients were mostly multiparous and this can add to the explanation of the clients being mostly Hausa and Muslims, who predominantly live in northern Nigeria with reported higher parity compared with the southern and eastern part of the country.[1]

The most common contraceptive method used by the clients was the injectable, which was similar to the findings from previous Zaria study and others from Kaduna, Ilorin, and Port Harcourt.[13],[15],[16],[17] Similarly, the studies from other African countries such as Ethiopia and Uganda showed that injectables were the most preferred methods of contraceptives.[18],[19] These findings have been attributed to their privacy and effectiveness.[18]

The discontinuation rate of 37.9% from this study is similar to the World Health Organization rate from the DHS of 25 countries.[7] It is close to the national discontinuation rate of 36.2 from the review of NDHS 2008 by Mobolaji et al. and from the DHS of Senegal with a rate of 35%.[20],[21] However, the discontinuation rate in this study was lower than that reported from Uganda (46.6%).[18] The discontinuation rate of 40.2% was reported among the Hausa/Fulani groups in the same national survey by Mobolaji et al. compared with other ethnic groups in Nigeria.[20] Thus, the high rate in this study can be explained by the predominant Hausa clients in the study. The discontinuation rate of contraceptives varies with age, ethnicity, occupation, residence (rural or urban), level of education, religion, age at first birth, number of children (<5), and with different methods of contraception.[1],[20],[21]

The most common reason for discontinuing a contraceptive method in this study was due to desire to conceive. The same reason was reported at the national level from the NDHS 2013 and the Senegal DHS 2016.[1],[22] Most of the women wanting to become pregnant depicts the fact that the clients were within reproductive age group and had not completed their family size. The study setting was in the region with the highest fertility rate in the country (6.7%).[1] The second common reason was due to method problems/health problems (menstrual irregularities), which differs from the NDHS 2013 report, which reported failure of method as the second most common reason. However, it was similar to the Senegal DHS report with health problems or side effects ranking the second most common reason for contraceptive discontinuation.[22] The health problems or method problems such as menstrual irregularities have been associated with hormonal contraceptives and women need to be appropriately educated and counselled on side effects of any contraceptive in order to clear doubts and myths among our women. Informing clients about contraceptive side effects were reported to have no significant effect on its use.[14]

From the assessment of the reasons for discontinuation of a contraceptive method, 53% of the clients in this study who discontinued a contraceptive method were “in need” for another contraceptive in order to prevent unwanted pregnancies but were not (have unmet need). The findings from the binary logistics regression revealed that a woman who discontinued a contraceptive method with an unmet need would likely be in the age group 30–34 years or with only Quranic education.[22]

 Conclusion



The uptake and discontinuation of contraceptives can be improved by the provision of adequate counseling and education regarding their side effects. Women should be given options to switch to safer methods when they discontinue a method or if they want to change.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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