Contraceptive Side Effects, Method Dissatisfaction, and Early Discontinuation

项目摘要 在世界范围内，意外怀孕和怀孕间隔时间短是造成贫穷的主要原因。 和儿童健康成果。全球计划生育倡议仍然侧重于促进获得 生殖健康服务和采用现代避孕方法，但努力了解原因 选择停止使用的妇女没有得到优先考虑。提前终止避孕，12岁以内 几个月的启动，被称为“漏桶”的避孕覆盖面，是一个实质性的 对FP的高未满足需求的驱动因素。证据表明，基于设施的FP护理的质量、方法类型和 避孕副作用的经验可能有助于早期方法中止。开发更 有效的方案，以改善妇女的经验和有效的长期使用避孕的妇女 需要FP的患者需要更深入地了解方法的不满意和中断， 副作用的经历和随后的停药之间的关系，以及用于评估 服务质量。在本提案中，将利用前瞻性队列研究的数据评价 避孕副作用、不满和避孕中止之间的关系， 产妇死亡率很高。 拟议的项目将利用来自肯尼亚孕产妇中1，254名新开始或继续进行现代FP的数据。 儿童健康（MCH）诊所研究数据是通过一种新型的移动的消息传递平台采集的， 定制的短信系统调查。调查衡量FP的使用、关注、副作用和 每周一次的满意度。这种前瞻性和动态的方法来远程收集数据，使用 移动的平台将为避孕药具的使用提供独特的见解。我们提出以下目标：1） 确定基线时接受的FP方法咨询质量与随后接受的FP方法咨询质量之间的关系 方法中止的风险，根据方法类型进行调整; 2）测量出血侧发作的时间 影响（闭经，点状出血，出血量较大），并确定与 在经历出血副作用的女性中继续使用该方法;以及3）测量患病率， 6个月时方法不满意的相关因素，包括方法类型、副作用经历、年龄， 怀孕意愿和关系状况。本研究的初步数据将用于为设计提供信息， 采取干预措施，支持继续采用生育间隔和限制生育的方法， 健康成果。

PROJECT SUMMARY Worldwide, unintended pregnancy and short pregnancy intervals contribute substantially to poor maternal and child health outcomes. Global family planning (FP) initiatives remain focused on promoting access to reproductive health services and uptake of modern methods of contraception, but efforts to understand why women choose to discontinue use have not been prioritized. Early contraceptive discontinuation, within 12 months of initiation, has been termed the “leaking bucket” of contraceptive coverage and is a substantial driver of high unmet need for FP. Evidence suggests quality of facility-based FP care, method type, and experience of contraceptive side effects may contribute to early method discontinuation. Development of more effective programs to improve women's experiences and effective long-term use of contraception for women in need of FP will require deeper understanding of method dissatisfaction and discontinuation, relationships between experience of side effects and subsequent discontinuation, and standardized metrics for evaluating quality of service delivery. In this proposal, data from a prospective cohort study will be leveraged to evaluate the relationships between contraceptive side effects, dissatisfaction, and contraceptive discontinuation in a setting with high maternal mortality. The proposed project will utilize data from 1,254 newly initiating or continuing modern FP in Kenyan maternal and child health (MCH) clinics. Study data was captured through a novel mobile messaging platform, using tailored short message system (SMS) surveys. Surveys measure FP use, concerns, side effects, and satisfaction on a weekly basis. This prospective and dynamic approach to remotely collect data using the mobile platform will provide unique insights into contraceptive use. We propose the following aims: 1) to determine the relationship between quality of FP method counseling received at baseline and subsequent risk of method discontinuation, adjusting for method type; 2) to measure the time of onset of bleeding side effects (amenorrhea, spotting, heavier bleeding), and identify participant characteristics associated with method continuation among women who experience bleeding side effects; and 3) to measure prevalence and correlates of method dissatisfaction by 6 months, including method type, experience of side effects, age, pregnancy intention, and relationship status. Pilot data from this study will be used to inform the design of interventions to support method continuation for birth spacing and limiting, and improve maternal and child health outcomes.