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'Failed' contraception in a rural South African population
1Department of Obstetrics and Gynaecology, Philadelphia Hospital (MEDUNSA Satellite Campus), Dennilton, Mpumalanga.
Objective:
To investigate whether the free availability of contraception affects the need for termination of pregnancy (TOP).
Design:
Case-control study.
Setting:
South African rural hospital.
Population:
Three thousand and ninety-five TOP seekers and 439 non-pregnant controls.
Methods:
Structured questionnaire followed by ultrasonography.
Main Outcome Measures:
Current use or recent discontinuation of contraception and the reason for discontinuation.
Results:
Less than one-third (28.6%) of TOP seekers claimed to be using contraception versus 85.0% of controls. Injectable contraception (IC) was preferred by the controls and oral contraception (OC) by TOP seekers (chi 2 = 48.5, p < 0.0001, OR 0.34 (95% confidence interval 0.25, 0.46)). The percentage of discontinuation of hormonal contraception was higher in controls (chi 2 = 6.3, p = 0.012, OR 0.51 (0.31, 0.85)). The reason for discontinuation of hormonal contraception was obtained from 31.2% of TOP seekers and 63.3% of controls; no reason for discontinuation was acknowledged by 30.1% of the former and 6.3% of the latter (chi 2 = 33.4, p < 0.0001, OR 6.40 (3.25, 12.56)). Side-effects of hormonal contraception prompted more discontinuation in the failed-contraception group (chi 2 = 120.5, p < 0.0001, OR 49.4 (21.6, 112.5)). Poor compliance and absence of an acknowledged reason for discontinuing hormonal contraception resulted in 173 unwanted pregnancies.
Conclusion:
In South Africa two main components of women's reproductive health and rights are freely available, namely contraception and TOP. Not using contraception is one of the main causes of unwanted pregnancy. Better education of both service providers and users is needed to improve use, compliance and perseverance with contraception.