Understanding factors associated with continuation of use of injectable contraceptives in Karnataka and Maharashtra, India: a cross-sectional household study
Gates Open Research
Abstract and Figures
The Government of India has worked to expand access to injectable contraceptives through the introduction of a three-monthly injectable contraceptive MPA under the ‘Antara’ program in 2017. However, the uptake of injectable contraceptives has remained low, and few studies have investigated the experiences of public health facility injectable clients in India. We examined factors associated with continuing, discontinuing, and switching methods among injectable users obtaining services from public health facilities in the Indian states of Karnataka and Maharashtra.
The study team recruited respondents (N=1009) that had received their first injectable dose from in public sector facilities between February – May 2019 and conducted a follow-up visit at their residence in December 2020. We used multivariate logistic regression to study the association of the demographic characteristics, service quality, satisfaction with services, follow-up visits, and decision-making on injectable continuation and switching to other family planning methods.
Injectable usage rates declined significantly, with 44% of clients receiving a second dose and only 16% receiving a third dose. Over half of women (54%) cited problems related to periods as the reason for discontinuing injectable use after the first dose. Respondents were more likely to continue their method at third dose if they were older (25-35 years) (OR:1.68, p<0.05) and had received a reminder for a follow-up dose (OR: 2.41, p
Our results also highlight the importance of addressing side-effects experience by women, which may be better managed by community-based follow-up visits and high-quality counselling services.
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... However, male sterilization rates remain low, highlighting the need for targeted awareness campaigns to increase male participation in FP programs. There is a substantial rise in the percentage of healthcare workers engaging with female [7] In a study using NFHS-4 data, Fernanda Ewerling et al. [8] found that 71.8% of women with partners aged 15-49 years used modern contraceptives, predominantly female sterilization. Regional variation was substantial, from 23.6% in Manipur to 93.6% in Andhra Pradesh. ...
... The underutilization of FP services in Karnataka, as well as in many other regions, is a multifaceted and complex issue influenced by various factors. These factors, as described in Figure 3, [4,7] significantly impact the overall maternal health and perinatal outcomes, making them a crucial area of study and intervention. ...
A BSTRACT
Background
Family planning (FP) services are pivotal in assessing a country’s healthcare efficacy. Despite India’s strides in FP promotion, disparities persist in its utilization rates. This study analyzes Karnataka’s FP trends by using National Family Health Survey (NFHS) rounds 4 and 5, comparing its indicators with national averages.
Methods
A retrospective record review-based descriptive study design was employed. Data from NFHS-4 (2015–16) and NFHS-5 (2019–21) were analyzed using MS Excel 365. Key variables included age at marriage, total fertility rate (TFR), and various contraceptive methods.
Results
Karnataka exhibited a stable rate of early marriages for women and a decline among men aged 25–29 years. TFR in Karnataka slightly decreased, with increased contraceptive usage and significant growth in modern contraceptive methods. However, male sterilization rates remained low. There was an improvement in health workers’ engagement with female non-users and in providing information on contraceptive side effects.
Conclusion
While Karnataka has progressed in FP, challenges such as early marriages persist. Enhancing integration, leveraging technology, and empowering women are essential for comprehensive FP services in India.
Approximately 214 million women of reproductive age lack adequate access to contraception for their family planning needs, yet patterns of contraceptive availability have seldom been examined. With growing demand for contraceptives in some areas, low contraceptive method availability and stockouts are thought to be major drivers of unmet need among women of reproductive age, though evidence for this is limited. In this research, we examined trends in stockouts, method availability and consumption of specific contraceptive methods in urban areas of four sub-Saharan African countries (Burkina Faso, Democratic Republic of Congo, Kenya and Nigeria) and India. We used representative survey data from the Performance Monitoring for Action Agile Project that were collected in quarterly intervals at service delivery points (SDP) stratified by sector (public vs private), with all countries having five to six quarters of surveys between 2017 and 2019. Among SDPs that offer family planning, we calculated the percentage offering at least one type of modern contraceptive method (MCM) for each country and quarter, and by sector. We examined trends in the percentage of SDPs with stockouts and which currently offer condoms, emergency contraception , oral pills, injectables, intrauterine devices and implants. We also examined trends of client visits for specific methods and the resulting estimated protection from pregnancy by quarter and country. Across all countries, the vast majority of SDPs had at least one type of MCM in-stock during the study period. We find that the frequency of stockouts varies by method and sector and is much more dynamic than previously thought. While the availability and distribution of long-acting reversible contraceptives (LARCs) were limited compared to other methods across countries, LARCs nonetheless consistently accounted for a larger portion of couple years of protection. We V C The Author(s) discuss findings that show the importance of engaging the private sector towards achieving global and national family planning goals.
Introduction: The safety and effectiveness of Depot Medroxyprogesterone Acetate (DMPA) (available by the
name of “Antara” in Government of India supply) has resulted in inclusion of this injectable contraceptive in
the basket of family planning choices and thus has opened the way for clients to avail of a safe, effective, and
hassle‑free method with full confidentiality, which is also free of cost in public health facilities all over India.
Material and Methods: This community‑based study with cross‑sectional design was conducted during
April 2019–October 2019. During first 3 months of the study, all the females who adopted the DMPA
contraception were included in the study and the factors for opting DMPA were assessed.
Results: Among those who had previously used contraceptives, oral pills were the most prevalent method.
Most of the clients who opted to DMPA agreed that they switched because of privacy and confidentiality
attached to DMPA. The side effects were reported by more than four‑fifth of subjects, and the most common
side effects were irregular spotting per vaginally, amenorrhea, and weight gain.
Conclusion: The present study has shown some light regarding the factors responsible for injectable DMPA
uptake as a family planning method and the facilitators and barriers to consistent injectable DMPA use.
The study findings are expected to be utilized for framing policies to improve compliance of DMPA and
making it more acceptable, client‑friendly initiative.
Maternal health has been a priority in India with the maternal health programs evolving over time. The maternal mortality ratio has decreased tremendously and India's journey in decline of maternal mortality is a story which needs to limelighted and discussed. The contributions by various health programs and organizations has played major role in India's success story. Although the Millennium Developmental Goal target was missed, the Sustainable Development Goal target can still be met if decline tends to continue at the same rate. The article reflects the brief outline of evolution of maternal health programs. We recommend strengthening of policy on person centered care, with the caveat that unless implementation hurdles in existing policy are addressed, such as infrastructure, human resources and supplies, policies on patient centered care may not be effectively implemented. Quality care must be provided and reaching the unreached will help in progressing towards the target.
Background: This modern era talks about women strength and empowerment where they are working either equally or one step ahead of men. However, a fall back in making decisions for contraception use and family planning can still be observed. It is most frequently seen among women belonging to some village as they are exposed to a minimal health care. Keeping this in mind, this crucial period was considered as opportunity to test the issue regarding the various choices of contraception available. Objective of this study was to find out the criteria and methods of contraception selected by women in the postpartum period.Methods: A cross-sectional study in the department of obstetrics and gynaecology was conducted over a period of 11/2 years in which a total of 150 postpartum women were interrogated and counselled regarding various methods of contraception.Results: The contraceptive methods most commonly selected in postpartum period are PPIUCD, Barrier, tubal ligation and injectable contraception of which condom is the most common method adopted. The important factors responsible for the choice of contraception include parity, breast- feeding, education and socio-economic status of the women.Conclusions: Postpartum period is particularly important for initiating contraception as the largest proportion with unmet need of contraception is found among those in their first year after child birth. In order to space birth in a healthy manner postpartum contraception should be emphasized upon.
All living organism reproduces in order to continue its kind on earth.
However, food chains and food webs control uncontrolled growth in the
population of living organisms. But, the uncontrolled growth of human
population can’t be controlled by nature alone. For this, couples adopt family
planning measures. These measures/methods are adopted by couples in order
to control the numbers of children they desire to have and also the gap (in
years) between two children. In this paper, how the family planning practices
are affected by different demographic and socio-economic variables and desire
for future birth in Manipur has been studied and it reveals that family planning
methods are adopted by couples irrespective of their socio-economic and
demographic factors.
Background
The GAP between the knowledge of contraception and its actual practice is well recognized in the literature of family welfare studies. The present study assessed the relation between the level of knowledge and practice of contraception among the women and sought to explore the reasons behind the Knowledge, Attitude, and Practice - GAP (KAP GAP) regarding contraceptive users in six cities of Uttar Pradesh. Method
Present analysis based on 17,643 currently married women aged 15 to 49. A Bivariate analysis (χ2 test) and a multivariable logistic regression were performed for the study. ResultThe highest percentages of respondents (women) were in the age group 35–49 (40–45 %) in all the districts considered. Knowledge of contraceptives was almost universal; tubal ligation and pill were the commonly known methods. Information about the contraceptive methods was mostly obtained through the husband. In the present study, there was a highly significant association (p < 0.01) of age group, educational status of respondents, the number of living children, the wealth of the respondent, media exposure and husband’s education with the variable KAP GAP for all six cities. Health concern issues in all the districts were the most prominent reason for not using contraception. Conclusion
There differences in the socioeconomic and demographic factors exist, which lead to KAP GAP in the family planning (FP) usages. Therefore, in designing effective family planning programme, there is a need to understand the various factors which influence the practice of contraception.
Increasing choice and introducing new contraceptive methods in the National Family Welfare Program in India could play a significant role in increasing adoption of contraception and meeting the unmet need of a large proportion of couples. However, inclusion of any new contraceptive method in India has to face many challenges at different steps: from clinical trials, administrative processes, acceptance in the national program, and reaching the intended beneficiaries. Having a good product is necessary but not sufficient for widespread accessibility, acceptance, and use. This article reviews the challenges based on the available policy documents, literature review, and discussions with senior program managers of the Ministry of Health and Family Welfare and development organizations. It concludes that comprehensive strategic planning is needed to address all possible barriers to ensure new contraceptive access at an affordable price by the beneficiaries it is intended for.
