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Differential discontinuation by covert use status in Kenya
Dana Sarnak1, Shannon N Wood1, Phil Anglewicz1
1Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Contraception: X
|November 6, 2023
Summary
Covert contraception users face higher discontinuation risks, especially after two years. Increased support and counseling are vital for these individuals to ensure continued access to reproductive health services.
Area of Science:
- Reproductive Health
- Contraception Research
- Sociomedical Sciences
Background:
- Qualitative studies indicate covert contraceptive users may discontinue methods due to discretion and disclosure fears.
- This study quantifies discontinuation rates for covert versus overt contraceptive users.
Purpose of the Study:
- To quantify the risk of contraceptive discontinuation among covert users compared to overt users.
- To analyze the time-dependent nature of discontinuation risk in covert contraceptive use.
Main Methods:
- Utilized a national longitudinal survey from Kenya (2019-2021).
- Employed survival analyses to compare discontinuation time over 5 years for covert and overt users.
- Multivariate Cox regression assessed the interaction between time and covert use on discontinuation risk.
Main Results:
- An interaction between time and covert use increased discontinuation risk (3% per month, p=0.02).
- No significant difference in discontinuation at 1-2 years (aHR 0.95-1.37).
- Significantly higher discontinuation risk for covert users at 3, 4, and 5 years (aHR 1.99-4.18).
Conclusions:
- Covert users face escalating discontinuation risks after the initial two years of contraceptive use.
- Enhanced support, counseling, and follow-up are crucial for covert contraceptive users.
- Family planning programs must prioritize privacy and access for covert users.
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