Factors associated with oral contraceptive discontinuation in rural Bangladesh
Factors associated with oral contraceptive discontinuation in rural Bangladesh
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DOI：
10.1093/heapol/18.1.101
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发表时间：
2003-03-01
影响因子：
3.2
通讯作者：
Khan, MA
中科院分区：
文献类型：
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作者：
Khan, MA
口服避孕药（OC）占孟加拉国使用的所有现代避孕方法的一半，然而，口服避孕药的停用率仍然相当高。本文确定了与停止使用 OC 相关的因素，其中停止是指在调查前 6 个月内停止使用 OC。本研究的数据取自对孟加拉国农村地区 OC 依从性的调查。总共采访了 1600 名年龄在 15 至 49 岁之间的当前或过去的 OC 用户；其中，36% 停止使用口服避孕药。在停药的女性中，47% 的人表示副作用是停药的主要原因。多变量分析表明，缺乏现场工作人员的访问是 OC 中止的最强预测因素；没有实地工作人员拜访过的女性停止使用口服避孕药的风险是原来的四倍。随着使用时间的增加和存活儿童数量的增加，停止使用口服避孕药的情况减少。停药与副作用经历、丈夫在使用 OC 方面缺乏支持以及未能购买 OC 相关。令人非常担忧的是，大约 70% 有意外怀孕风险的女性在停药后没有使用任何避孕方法。丈夫的教育程度与用另一种避孕方法替代口服避孕药呈正相关。应通过充分的咨询来提倡有效使用口服避孕药，包括如何正确服用、副作用的可能性及其适当的管理，更重要的是，如果口服避孕药不能令人满意或不合适，可以采用可能的替代避孕方法。更好的提供者与客户互动以及改善新建立的社区诊所的使用可能有助于持续有效地使用 OC。
Oral contraceptives (OCs) account for half of all modern contraceptive methods used in Bangladesh, however, discontinuation remains fairly high in OC use. This paper identifies factors associated with discontinuation of OC use, where discontinuation refers to cessation of OC use in the 6 months prior to the survey. The data for this study were drawn from a survey on OC compliance in rural Bangladesh.A total of 1600 OC users, current or past, aged 15 to 49 years were interviewed; of these, 36% discontinued OC use. Of the women who discontinued, 47% reported the experience of side-effects as the main reason for OC discontinuation. Multivariate analysis identified lack of fieldworker's visit as the strongest predictor of OC discontinuation; women who were not visited by fieldworkers had a four-fold risk of discontinuing OC use. Discontinuation of OC use decreased with increased duration of use and number of living children. OC discontinuation was associated with side-effect experiences, lack of husband's support in OC use and failure to purchase OCs. Of great concern is that about 70% of the women who were at risk of unintended pregnancy were not using any method of contraception following OC discontinuation. Husband's education was positively associated with the substitution of OCs with another contraceptive method.Effective OC use should be advocated through adequate counselling about how to take it correctly, the possibility of side-effects and their proper management and, more importantly, the possible alternative contraceptive method should OCs prove unsatisfactory or unsuitable. Better provider-client interactions along with improved access to the newly established community clinics could be instrumental in the continued and effective use of OCs.