The role of partner influence in contraceptive adoption, discontinuation, and switching in a nationally representative cohort of Ugandan women.
The role of partner influence in contraceptive adoption, discontinuation, and switching in a nationally representative cohort of Ugandan women.
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DOI：
10.1371/journal.pone.0238662
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Moreau C
中科院分区：
文献类型：
--
作者：
Sarnak DO;Wood SN;Zimmerman LA;Karp C;Makumbi F;Kibira SPS;Moreau C
了解避孕药具使用动态对于解决避孕药具需求未得到满足的问题至关重要。尽管有证据表明，男性伴侣可能会影响避孕决策，但很少有研究前瞻性地探讨男性影响妇女使用和继续避孕的支持方式。本研究旨在了解预测效果的合作伙伴的影响，定义为合作伙伴的生育意愿和支持避孕，并讨论避免怀孕前避孕，避孕药使用动态（继续，停止，转换，通过）超过一年的时间。这项研究使用了2018-2019年收集的15-49岁乌干达妇女的全国代表性纵向数据（n = 4，288名妇女基线; n = 2，755名妇女一年随访）。使用了两个分析子样本，即基线时处于结合状态和需要避孕的女性（n = 618例基线时避孕使用者用于停药/转换分析; n = 687例基线时避孕未使用者用于采用分析）。主要因变量包括避孕药具的使用动态（继续，中止，转换，并通过）;三个独立的变量评估合作伙伴的影响。对于每个子样本，双变量协会探讨避孕动态的社会人口和合作伙伴的影响的差异。使用多项回归模型检查基线时避孕药具使用者的停药和转换;逻辑回归确定基线时非使用者避孕药具采用的预测因素。在基线时的使用者中，26.3%的妇女改变了方法，31.5%的妇女在随访时停止使用避孕药具。根据女性特征进行调整的多项逻辑回归表明，当女性在使用避孕药之前没有与伴侣讨论避免怀孕时，避孕药停用的相对风险会增加一倍。合作伙伴的影响是不相关的方法切换。在基线时的非使用者中，伴侣对未来避孕药具使用的支持与避孕药具采用几率增加近三倍相关。这些结果突出了男性伴侣在避孕药具采用方面的潜在支持作用。鼓励今后的研究通过进一步的前瞻性研究阐明夫妇为基础的决策和避孕动态之间的复杂途径。
Understanding contraceptive use dynamics is critical to addressing unmet need for contraception. Despite evidence that male partners may influence contraceptive decision-making, few studies have prospectively examined the supportive ways that men influence women’s contraceptive use and continuation. This study sought to understand the predictive effect of partner influence, defined as partner’s fertility intentions and support for contraception, and discussions about avoiding pregnancy prior to contraceptive use, on contraceptive use dynamics (continuation, discontinuation, switching, adoption) over a one-year period. This study uses nationally representative longitudinal data of Ugandan women aged 15–49 collected in 2018–2019 (n = 4,288 women baseline; n = 2,755 women one-year follow-up). Two analytic sub-samples of women in union and in need of contraception at baseline were used (n = 618 contraceptive users at baseline for discontinuation/switching analysis; n = 687 contraceptive non-users at baseline for adoption analysis). Primary dependent variables encompassed contraceptive use dynamics (continuation, discontinuation, switching, and adoption); three independent variables assessed partner influence. For each sub-sample, bivariate associations explored differences in sociodemographic and partner influences by contraceptive dynamics. Multinomial regression models were used to examine discontinuation and switching for contraceptive users at baseline; logistic regression identified predictors of contraceptive adoption among non-users at baseline. Among users at baseline, 26.3% of women switched methods and 31.5% discontinued contraceptive use by follow-up. Multinomial logistic regression, adjusting for women’s characteristics, indicated the relative risk of contraceptive discontinuation doubled when women did not discuss pregnancy avoidance with their partner prior to contraceptive use. Partner influence was not related to method switching. Among non-users at baseline, partner support for future contraceptive use was associated with nearly three-fold increased odds of contraceptive adoption. These results highlight the potentially supportive role of male partners in contraceptive adoption. Future research is encouraged to elucidate the complex pathways between couple-based decision-making and contraceptive dynamics through further prospective studies.
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