Contraceptive Side Effects, Method Dissatisfaction, and Early Discontinuation

项目总结 在世界范围内，意外怀孕和怀孕间隔短在很大程度上导致了产妇的贫穷。 和儿童健康结果。全球计划生育(FP)倡议的重点仍然是促进获得 生殖健康服务和现代避孕方法的采用，但努力了解为什么 选择停止使用的妇女尚未被优先考虑。提前停止避孕，在12天内 几个月的启动，被称为避孕覆盖率的“漏水桶”，是一个实质性的 高度未满足的FP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及早停用该方法。开发更多 改善妇女体验和长期有效使用避孕药具的有效方案 需要FP将需要更深入地理解方法的不满和中断、关系 副作用的体验和随后的停药之间的关系，以及评估的标准化指标 服务交付质量。在这项建议中，来自前瞻性队列研究的数据将被用来评估 老年人避孕副反应、不满意度与停止避孕的关系 在孕产妇死亡率较高的情况下。 拟议的项目将利用肯尼亚孕产妇中1,254名新开始或继续进行的现代计划生育的数据 和儿童保健(MCH)诊所。研究数据是通过一个新的移动消息平台捕获的，使用 量身定做的短信系统(短信)调查。调查衡量FP的使用、关注事项、副作用和 每周都有满足感。这种前瞻性的、动态的方法使用 移动平台将为避孕用具的使用提供独特的见解。我们提出以下目标：1) 确定基线和后续的FP方法咨询质量之间的关系 方法中断的风险，根据方法类型进行调整；2)测量出血侧的发病时间 影响(闭经、斑点、出血增多)，并确定与以下各项相关的参与者特征 方法在有出血副作用的妇女中继续进行；3)测量患病率和 6个月内方法不满意的相关因素，包括方法类型、副作用经验、年龄、 怀孕意向和关系状况。这项研究的试点数据将用于指导设计 支持延续生育间隔和限制生育方法的干预措施，并改善孕产妇和儿童 健康结果。

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.