Factors associated with early long-acting reversible contraceptives discontinuation in Ethiopia: evidence from the 2016 Ethiopian demographic and health survey.

BACKGROUND: Ethiopia is struggling to achieve the 2020 family planning target. But the current contraceptive prevalence uptake is low and dominated by short-acting methods. Contraceptive discontinuation rate is also high. This analysis was done to identify the reasons and factors associated with long-acting and reversible contraceptives (LARC) discontinuation in Ethiopia. METHODS: The unit of analysis was LARC-use episodes in the 5 years preceding the survey, generated from the 2016 Ethiopian Demographic and Health Survey data. A total of 1385 LARC episodes were included. Data analysis was done using STATA 15. The event file generated from the contraceptive calendar was merged to the original data set to identify factors associated with LARC discontinuation. Univariate, bivariate and inferential analyses were done for 12 months LARC discontinuation. RESULT: Approximately 82% of LARC episodes were implants. About 45% of intrauterine device (IUD) and 61% of implant episodes were discontinued by 36 months. Side effects and the desire to become pregnant were the main reasons for discontinuation. Women aged 25-34 (HR = 0.26; 95% CI: 0.20-0.35) and those aged 35-49 (HR = 0.17; 95%CI: 0.11-0.26), women who participated in decision-making partially (HR = 0.53; 95%CI: 0.37-0.78), or fully (HR = 0.55; 95%CI: 0.40-0.74) and primiparous women (HR = 0.53, 95%CI: 0.33-0.86) had a lower hazard of discontinuing LARCs. On the other hand, women who had only primary education (HR = 1.32; 95%CI: 1.02-1.72) and women who were not sure about their fertility intention (HR = 2.11; 95%C: 1.28-3.46) had a higher likelihood of discontinuing these methods. CONCLUSION: Majority of LARC episodes were discontinued early, mainly due to the desire for pregnancy or experience of side effects. Older women, particularly those involved in household decision-making, and primipara were less likely to discontinue LARC. Women with only primary education and those uncertain about their fertility intention had a higher likelihood of discontinuation. Family planning service providers should focus on fertility intention and side effects when counseling women for contraceptive choice. Improving women's participation in household decision-making may decrease LARC discontinuation in Ethiopia.

Correction: Determinants of change in long-acting or permanent contraceptives use in Ethiopia; A multivariate decomposition analysis of data from the Ethiopian demographic and health survey.

[This corrects the article DOI: 10.1371/journal.pone.0227218.].

Determinants of change in long-acting or permanent contraceptives use in Ethiopia; A multivariate decomposition analysis of data from the Ethiopian demographic and health survey.

BACKGROUND: There has been an increase in the uptake of long-acting or permanent contraceptive methods (LAPMs) in Ethiopia. Identifying the factors associated with this change is important for designing interventions that will further accelerate the uptake. This study was done to identify components of, and factors associated with, changes in the use of LAPMs in Ethiopia. METHODS: Information about 16,336 married or in-union reproductive-age women were extracted from the 2005 and 2016 Ethiopian Demographic and Health Surveys (EDHS). Normalized weighting was used to compensate for disproportionate sampling and non-response in the survey. The two data sets were merged and analyzed using multivariate decomposition analysis. RESULT: From 2005 to 2016, the use of LAPMs increased by 12.0 percentage points. Changes in the characteristics of women (compositional factors) were responsible for nearly 7.0% of the observed difference. Most of the change (92.0%) was attributable to differences in the effects of characteristics. Age, working status, woman's occupation, concordance on the desired number of children between women and their partners, and a visit by health workers in the 12 months before the survey were all significantly associated with the change. CONCLUSION: The contribution of variation in the survey population structure was not significant for the observed change. The change in the use of LAPMs was mainly due to behavioral changes among older, educated and working women, and women visited by health workers.

Factors associated with long acting and permanent contraceptive methods use in Ethiopia.

BACKGROUND: Long acting and permanent contraceptives methods are more effective, save cost and enable women to control their reproductive lives better. Although the Ethiopian government is promoting its use through various mechanisms, the level of use is low. Therefore, this study was designed to identify factors associated with long acting and permanent contraceptive methods use in Ethiopia. METHODS: Four Ethiopian demographic and health survey data were used to examine trends of long acting and permanent contraceptive methods use. To identify factors associated with long acting and permanent contraceptive methods use, the 2016 Ethiopian demographic and health survey data was used. The data was accessed from the demographic and health survey program data base. Data analysis was done using Stata 15.1. Descriptive analysis was used to describe socio-economic and other variables of the study participants. Data were weighted and design effect was considered during analysis. Multicollinearity was assessed using variance inflation factor. Finally, multinomial logistic regression model was used to identify factors associated with long acting and permanent contraceptive methods use. RESULTS: Long acting and permanent contraceptive methods use increased significantly from 0.6% in 2000 to 11.6% in 2016. The odds of long acting and permanent contraceptive methods use was higher among richer women (AOR 2.6; 95%CI 1.2-5.4), women who were sales workers (AOR 2.1; 95%CI 1.1-3.9) and women whose ideal number of children was high (AOR; 4.2, 95%CI 1.4-13.0). But the odds of long acting and permanent contraceptive methods use was lower among female headed households (AOR 0.2: 95%CI 0.1-0.5) and women who had history of abortion (AOR 0.2: 95%CI 0.1-0.5). CONCLUSION: Long acting and permanent contraceptive methods use increased significantly in Ethiopia. Wealth index, women's occupation, ideal number of children, sex of head of the household and history of abortion were factors associated with long acting and permanent contraceptive methods use in Ethiopia. Improving economic status of women may help improve long acting and permanent contraceptive methods use in Ethiopia.

Paid work, domestic work, and other determinants of pregnancy outcome in Ibadan, southwest Nigeria.

OBJECTIVE: To identify the determinants of low birth weight (LBW), preterm birth, and stillbirth, and the factors associated with paid or domestic work that affected pregnancy outcome in Ibadan, Nigeria. METHODS: A cross-sectional study of women who delivered live or stillborn singleton neonates at 4 hospitals between February and June 2008. Participants were interviewed to obtain information on paid and domestic work activities during pregnancy, as well as obstetric history. Pregnancy outcomes and other clinical data were extracted from case notes. RESULTS: A total of 1504 mothers aged 20-45 years recorded 137 (9.1%) LBW neonates (<2.5 kg), 154 (10.2%) preterm deliveries (<37 weeks), and 56 (3.7%) stillbirths. There was no overall increased risk of these outcomes among working mothers. Multivariate logistic regression analysis of working mothers who had booked their deliveries revealed that lifting heavy objects at home, a clinical record of proteinuria, and hospital admission during pregnancy were associated with LBW. Predictors for preterm birth were self-reported exposure to vibration at work, nulliparity, history of preterm birth, 4 or fewer compared with more than 8 antenatal visits, and prolonged rupture of membranes. Predictors for stillbirth were low education and prolonged rupture of membranes. CONCLUSION: The results further support recommendations that physical exertion in paid and domestic work should be reduced during pregnancy.