Factors influencing use of long-acting versus short-acting contraceptive methods among reproductive-age women in a resource-limited setting.

BACKGROUND: Unplanned pregnancy remains a common problem in many resource-limited settings, mostly due to limited access to modern family planning (FP) services. In particular, use of the more effective long-acting reversible contraceptive (LARC) methods (i.e., intrauterine devices and hormonal implants) remains low compared to the short-acting methods (i.e., condoms, hormonal pills, injectable hormones, and spermicides). Among reproductive-age women attending FP and antenatal care clinics in Uganda, we assessed perceptions and practices regarding the use of modern contraceptive methods. We specifically aimed to evaluate factors influencing method selection. METHODS: We performed a mixed-methods cross-sectional study, in which we administered structured interviews to 180 clients, and conducted 4 focus group discussions (FGDs) with 36 clients and 8 in-depth personal qualitative interviews with health service providers. We summarized quantitative data and performed latent content analysis on transcripts from the FGDs and qualitative interviews. RESULTS: The prevalence of ever use for LARC methods was 23%. Method characteristics (e.g., client control) appeared to drive method selection more often than structural factors (such as method availability) or individual client characteristics (such as knowledge and perceptions). The most common reasons for choosing LARC methods were: longer protection; better child-spacing; and effectiveness. The most common reasons for not choosing LARC methods included requiring a client-controlled method and desiring to conceive in the near future. The most common reasons for choosing short-acting methods were ease of access; lower cost; privacy; perceived fewer side effects; and freedom to stop using a method without involving the health provider. The personal characteristics of clients, which appeared to be important were client knowledge and number of children. The structural factor which appeared to be important was method availability. CONCLUSIONS: Our results suggest that interventions to improve uptake of LARC among reproductive age women in this setting should consider: incorporating desired method-characteristics into LARC methods; targeted promotion and supply of LARC; and increased counselling, sensitization, and education.

Water usage patterns in low-income urban communities in Uganda: implications for water supply surveillance.

The selection of water sources by poor households in three urban areas in Uganda is shown to be complex, with a range of communal water sources used. In all towns, significant numbers of households used multiple sources. An aggregated estimate of the level of use in the largest town, Kampala, showed little difference in the number of households collecting water from piped and non-piped sources. In the other towns, households in Soroti were more likely to use point sources than piped water and in Masaka most households used piped water, with unprotected sources the most common subsidiary source. Differentiation in use by source type was evaluated. In two of the towns no differentiation in use is seen. In Soroti, some differentiation in use is seen as the water from boreholes is widely used for drinking and that from other sources less frequently consumed. Supplemental water purchased from vendors was relatively uncommon in the towns, but two towns showed that many households collect rainwater for domestic use. The implications of these findings for the drinking water surveillance programme are discussed.