Predictors of contraceptive discontinuation among postpartum women in Arusha region, Tanzania

Michael J Mahande; Ryoko Sato; Caroline Amour; Rachel Manongi; Amina Farah; Sia E Msuya; Bilikisu Elewonibi; Iqbal Shah

doi:10.1186/s40834-021-00157-6

Predictors of contraceptive discontinuation among postpartum women in Arusha region, Tanzania

Contracept Reprod Med. 2021 May 3;6(1):15. doi: 10.1186/s40834-021-00157-6.

Authors

Michael J Mahande¹, Ryoko Sato², Caroline Amour³, Rachel Manongi⁴, Amina Farah⁴, Sia E Msuya^{3

4

5}, Bilikisu Elewonibi², Iqbal Shah²

Affiliations

¹ Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania. jmmahande@gmail.com.
² Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
³ Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania.
⁴ Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania.
⁵ Department of Community Health, KCMC Hospital, P.O Box 3010, Moshi, Tanzania.

Abstract

Background: Postpartum contraceptive discontinuation refers to cessation of use following initiation after delivery within 1 year postpartum. Discontinuation of use has been associated with an increased unmet need for family planning that leads to high numbers of unwanted pregnancies, unsafe abortion or mistimed births. There is scant information about contraceptive discontinuation and its predictors among postpartum women in Tanzania. This study aimed to determine predictors of contraception discontinuation at 3, 6, 12 months postpartum among women of reproductive age in Arusha city and Meru district, Tanzania.

Methods: This was an analytical cross-sectional study which was conducted in two district of Arusha region (Arusha city and Meru district respectively). A multistage sampling technique was used to select 13 streets of the 3 wards in Arusha City and 2 wards in Meru District. A total of 474 women of reproductive age (WRAs) aged 16-44 years residing in the study areas were included in this analysis. Data analysis was performed using STATA version 15. Odds ratios (ORs) with 95% confidence interval (CI) for the factors associated with contraceptives discontinuation (at 3, 6 and 12 moths) were estimated in a multivariable logistic regression model.

Results: Overall, discontinuation rate for all methods at 3, 6, and 12 months postpartum was 11, 19 and 29% respectively. It was higher at 12 months for Lactational amenorrhea, male condoms and injectables (76, 50.5 and 36%, respectively). Women aged 40-44 years had lower odds of contraceptive discontinuation at 3 months as compare to those aged 16 to 19 years. Implants and pills users had also lower odds of contraceptive discontinuation compared to injectable users at 3, 6 and 12 months respectively.

Conclusion: Lactational amenorrhea, male condoms and injectables users had the highest rates of discontinuation. Women's age and type of method discontinued were independently associated with postpartum contraceptive discontinuation. Addressing barriers to continue contraceptive use amongst younger women and knowledge on method attributes, including possible side-effects and how to manage complications is warranted.

Keywords: Contraceptive; Determinants; Discontinuation; Tanzania.