Side effects and the need for secrecy: characterising discontinuation of modern contraception and its causes in Ethiopia using mixed methods.
Side effects and the need for secrecy: characterising discontinuation of modern contraception and its causes in Ethiopia using mixed methods.
复制标题
DOI：
10.1186/s40834-017-0052-7
复制
发表时间：
2017
影响因子：
2.9
通讯作者：
Gurmu E
中科院分区：
文献类型：
--
作者：
Alvergne A;Stevens R;Gurmu E
停止避孕是减少全球未满足的计划生育需求的一个主要障碍，但妇女停止避孕的原因却知之甚少。在这里，我们使用来自埃塞俄比亚的数据来调查(i) 2005-2011年避孕停止的程度，（ii）停止的风险如何随方法类型和教育水平而变化，以及（iii）继续的障碍。我们的主要假设是，停用避孕药是由于使用激素避孕的生理副作用，而不是由于缺乏正规教育。我们采用混合方法解释序列设计，通过定性数据更详细地解释定量结果。首先，我们分析了2011年埃塞俄比亚人口与健康调查的定量数据，利用多层次多过程模型研究了避孕中止和方法选择的模式。其次，我们在埃塞俄比亚人口最多的三个地区与育龄个人和保健专业人员进行了半结构化访谈和焦点小组讨论。对EDHS数据的分析表明，2005-2011年期间停药率没有降低，而且仍然很高。中止主要采取放弃的形式，是方法类型、年龄和财富的函数，而不是教育水平的函数。对妇女和保健专业人员的采访表明，经历使人衰弱的生理副作用、需要保密和贫穷是继续的重要障碍。我们的研究结果表明，使用避孕药具的生理和社会副作用，而不是缺乏正规教育，是埃塞俄比亚放弃避孕药具的根本原因。
Contraceptive discontinuation is a major barrier to reducing global unmet needs for family planning, but the reasons why women discontinue contraception are poorly understood. Here we use data from Ethiopia to investigate (i) the magnitude of contraceptive discontinuation in 2005–2011, (ii) how the risk of discontinuation varies with method type and education level and (iii) the barriers to continuation. Our main hypothesis is that contraceptive discontinuation is driven by the experience of physiological side-effects associated with the use of hormonal contraception, rather than a lack of formal education. We used a mixed methods explanatory sequential design to explain the quantitative results in more details through the qualitative data. First, we analysed quantitative data from the 2011 Ethiopian Demographic and Health Survey to study patterns of contraceptive discontinuation and method choice using multilevel multiprocess models. Second, we conducted semi-structured interviews and focus group discussions in the 3 most populated regions of Ethiopia with individuals of reproductive age and health professionals. The analysis of EDHS data shows that the rate of discontinuation has not reduced in the period 2005–2011 and remains high. Discontinuation mainly takes the form of abandonment, and is a function of method type, age and wealth but not of educational level. Interviews with women and health professionals reveal that the experience of debilitating physiological side effects, the need for secrecy and poverty are important barriers to continuation. Our findings together suggest that physiological and social side-effects of contraceptive use, not a lack of formal education, are the root causes of contraceptive abandonment in Ethiopia.