Factors Associated with Failed Contraception in Women Attending Level One Hospitals in Lusaka, Zambia

Background: Unintended pregnancy is a major public health concern due to its impact on maternal morbidity and mortality. Contraceptive failure is one of the causes of unintended pregnancy. Data on factors associated with contraceptive method failure is scarce. This study therefore aimed to explore factors associated with contraceptive failure. Methodology: Unmatched case-control study was conducted at five Level One Hospitals in Lusaka. Convenience sampling was used to enrol 108 cases for whom pregnancy occurred while on a modern contraceptive method and 108 hospital-based controls who were on a modern contraceptive method and not pregnant. Binary and multiple logistic regressions were utilized for assessment of factors associated with failed contraception. Results: Among the 108 cases, 46 (42.6%), 40 (37%), 17 (15.7%) and 1 (0.9%) were on the oral contraceptive pill, injectable, implant and intrauterine device contraception methods respectively while 2 (1.9%) were on barrier and emergency contraceptive methods respectively. The odds of contraceptive failure when using the oral contraceptive pill was more than 7 times (AOR 7.790, 95% CI 1.210-50.161, p=0.031). Those who had contraception failure were more than 3 times more likely to be younger than 30 years old compared to those whose contraceptive method did not fail (AOR 3.559, 95% CI 1.100-11.521, p=0.034 and AOR 3.596, 95% CI 1.354-9.550, p=0.010 respectively for age groups 18-24 years and 24-30 years old). Other factors associated with higher odds of contraceptive failure were duration of marriage greater than one year, with the highest odds in those married for more than 10 years (AOR 9.744, 95% CI 2.232-42.537, p=0.002), higher social support (AOR 2.402, 95% CI 1.085-5.321, p=0.031), multiparity (AOR 15.299, 95% CI 3.034- 77.151, p=0.001), and duration of use of antecedent contraception method of more than 2-3 years (AOR 4.913, 95% CI 1.662-14.526, p=0.004). Conclusion: The oral contraceptive pill, younger age, marriage duration of more than one year and contraceptive use more than three years were associated with contraceptive failure. Good messaging and counseling on usage of the oral contraceptive pill are recommended.

Contraceptive failure after hysteroscopic sterilization: Analysis of clinical and demographic data from 103 unplanned pregnancies

OBJECTIVE: This investigation examined data on unplanned pregnancies following hysteroscopic sterilization (HS). METHODS: A confidential questionnaire was used to collect data from women with medically confirmed pregnancy (n=103) registered after undergoing HS. RESULTS: Mean (+/-SD) patient age and body mass index (BMI) were 29.5+/-4.6 years and 27.7+/-6.1 kg/m2, respectively. Peak pregnancy incidence was reported at 10 months after HS, although or =30 years and BMI <25 reported conception after HS somewhat sooner than younger patients, although the differences in time to pregnancy were not significant (P=0.24 and 0.09, respectively). The recommended post-HS hysterosalpingogram (to confirm proper placement and bilateral tubal occlusion) was obtained by 66% (68/103) of respondents. CONCLUSION: This report is the first to provide patient-derived data on contraceptive failures after HS. While adherence to backup contraception 3 months after HS can be poor, many unintended pregnancies with HS occur long after the interval when alternate contraceptive is required. Many patients who obtain HS appear to ignore the manufacturer's guidance regarding the post-procedure hysterosalpingogram to confirm proper device placement, although limited insurance coverage likely contributes to this problem. The greatest number of unplanned pregnancies occurred 10 months after HS, but some unplanned pregnancies were reported up to 7 years later. Age, BMI, or surgical history are unlikely to predict contraceptive failure with HS. Further follow-up studies are planned to capture additional data on this issue.

A profile of abortion cases in a Tertiary Care Hospital.

The present study was conducted in the Department of Obstetrics and Gynaecology in collaboration with Department of Forensic Medicine at Rohilkhand Medical College and Hospital, Bareilly, U.P. between October 2009 and September 2010. A total of 150 married women presented for termination of pregnancy were being studied. 38% of women were in the age group of 26-30 years followed by 34.7% in 18-25 years. Majority (78%) were Hindus; major chunk (74%) belonged to lower class, 57.3% were illiterates, and 74% were from rural background. 84.7% of the patients presented between 5-12 weeks of gestation for termination. Majority (63.3%) were having 1-3 deliveries. 67.3% patients had no history of prior abortion. 54.7% unsuccessfully attempted to terminate the present pregnancy by using various methods. In 30.7% of patient’s unplanned pregnancy was main reason for terminating pregnancy, followed by contraceptive failure (29.3%) and inadequate income (26.7%).