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Contributions of side effects to contraceptive discontinuation and method switch among Kenyan women: a prospective cohort study
OBJECTIVE: To determine the contribution of specific contraceptive side effects to method switch and modern‐method discontinuation among Kenyan women. DESIGN: A prospective cohort study. SETTING: Five counties in Western Kenya. PARTICIPANTS: Women aged ≥18 years old and emancipated female minors ≥14...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9035040/ https://www.ncbi.nlm.nih.gov/pubmed/34839583 http://dx.doi.org/10.1111/1471-0528.17032 |
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author | Rothschild, CW Richardson, BA Guthrie, BL Kithao, P Omurwa, T Mukabi, J Callegari, LS Lokken, EL John‐Stewart, G Unger, JA Kinuthia, J Drake, AL |
author_facet | Rothschild, CW Richardson, BA Guthrie, BL Kithao, P Omurwa, T Mukabi, J Callegari, LS Lokken, EL John‐Stewart, G Unger, JA Kinuthia, J Drake, AL |
author_sort | Rothschild, CW |
collection | PubMed |
description | OBJECTIVE: To determine the contribution of specific contraceptive side effects to method switch and modern‐method discontinuation among Kenyan women. DESIGN: A prospective cohort study. SETTING: Five counties in Western Kenya. PARTICIPANTS: Women aged ≥18 years old and emancipated female minors ≥14 years old using modern, reversible contraception were recruited while attending 10 public health facilities. METHODS: Patient‐reported adverse effect symptoms, method switch and discontinuation were reported through weekly text message‐based surveys for 24 weeks. MAIN OUTCOME MEASUREMENTS: Prevalence, hazards ratio (HR). RESULTS: Among 825 women, 44% were using implants, 43% injectables, 7% an intrauterine device and 6% oral contraceptive pills at enrolment. Most (61%) women were continuing a method used in the previous month. During the 24‐week follow up, incidence of contraceptive switch was 61.3 per 100 person‐years (95% confidence interval [CI] 52.4–71.8) and incidence of discontinuation was 38.5 per 100 person‐years (95% CI 31.6–47.0). On average, one‐quarter (prevalence [Pr] 0.24, 95% CI 0.22–0.26) of participants reported side effects or method problems weekly, with sexual side effects the most prevalent symptom (Pr 0.15, 95% CI 0.13–0.16). Lack of expected bleeding was associated with higher risk of method switch (adjusted hazard ratio [aHR] 2.36, 95% CI 1.22–4.57). Risk of all‐modern method discontinuation was higher among women experiencing irregular bleeding (aHR 2.39, 95% CI 1.20–4.77), weight changes (aHR 2.72, 95% CI 1.47–4.68) and sexual side effects (aHR 2.42, 95% CI 1.40–4.20). CONCLUSIONS: Addressing irregular bleeding, weight changes and sexual side effects through development of new products that minimise these specific side effects and anticipatory counseling may reduce method‐related discontinuation. TWEETABLE ABSTRACT: Bleeding, weight changes, sexual problems associated with discontinuation of #contraception, but many continue despite side effects. |
format | Online Article Text |
id | pubmed-9035040 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-90350402022-10-14 Contributions of side effects to contraceptive discontinuation and method switch among Kenyan women: a prospective cohort study Rothschild, CW Richardson, BA Guthrie, BL Kithao, P Omurwa, T Mukabi, J Callegari, LS Lokken, EL John‐Stewart, G Unger, JA Kinuthia, J Drake, AL BJOG Research Articles OBJECTIVE: To determine the contribution of specific contraceptive side effects to method switch and modern‐method discontinuation among Kenyan women. DESIGN: A prospective cohort study. SETTING: Five counties in Western Kenya. PARTICIPANTS: Women aged ≥18 years old and emancipated female minors ≥14 years old using modern, reversible contraception were recruited while attending 10 public health facilities. METHODS: Patient‐reported adverse effect symptoms, method switch and discontinuation were reported through weekly text message‐based surveys for 24 weeks. MAIN OUTCOME MEASUREMENTS: Prevalence, hazards ratio (HR). RESULTS: Among 825 women, 44% were using implants, 43% injectables, 7% an intrauterine device and 6% oral contraceptive pills at enrolment. Most (61%) women were continuing a method used in the previous month. During the 24‐week follow up, incidence of contraceptive switch was 61.3 per 100 person‐years (95% confidence interval [CI] 52.4–71.8) and incidence of discontinuation was 38.5 per 100 person‐years (95% CI 31.6–47.0). On average, one‐quarter (prevalence [Pr] 0.24, 95% CI 0.22–0.26) of participants reported side effects or method problems weekly, with sexual side effects the most prevalent symptom (Pr 0.15, 95% CI 0.13–0.16). Lack of expected bleeding was associated with higher risk of method switch (adjusted hazard ratio [aHR] 2.36, 95% CI 1.22–4.57). Risk of all‐modern method discontinuation was higher among women experiencing irregular bleeding (aHR 2.39, 95% CI 1.20–4.77), weight changes (aHR 2.72, 95% CI 1.47–4.68) and sexual side effects (aHR 2.42, 95% CI 1.40–4.20). CONCLUSIONS: Addressing irregular bleeding, weight changes and sexual side effects through development of new products that minimise these specific side effects and anticipatory counseling may reduce method‐related discontinuation. TWEETABLE ABSTRACT: Bleeding, weight changes, sexual problems associated with discontinuation of #contraception, but many continue despite side effects. John Wiley and Sons Inc. 2022-01-18 2022-05 /pmc/articles/PMC9035040/ /pubmed/34839583 http://dx.doi.org/10.1111/1471-0528.17032 Text en © 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Articles Rothschild, CW Richardson, BA Guthrie, BL Kithao, P Omurwa, T Mukabi, J Callegari, LS Lokken, EL John‐Stewart, G Unger, JA Kinuthia, J Drake, AL Contributions of side effects to contraceptive discontinuation and method switch among Kenyan women: a prospective cohort study |
title | Contributions of side effects to contraceptive discontinuation and method switch among Kenyan women: a prospective cohort study |
title_full | Contributions of side effects to contraceptive discontinuation and method switch among Kenyan women: a prospective cohort study |
title_fullStr | Contributions of side effects to contraceptive discontinuation and method switch among Kenyan women: a prospective cohort study |
title_full_unstemmed | Contributions of side effects to contraceptive discontinuation and method switch among Kenyan women: a prospective cohort study |
title_short | Contributions of side effects to contraceptive discontinuation and method switch among Kenyan women: a prospective cohort study |
title_sort | contributions of side effects to contraceptive discontinuation and method switch among kenyan women: a prospective cohort study |
topic | Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9035040/ https://www.ncbi.nlm.nih.gov/pubmed/34839583 http://dx.doi.org/10.1111/1471-0528.17032 |
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