CONTRACEPTIVE METHOD MIX
1.3.4 CONTRACEPTIVE METHOD MIX
1.3.4.1 Current Contraceptive Practice
Less than a third (29.7%) of all women (N=848) reported use of a contraceptive method at the time ofthe survey. The most commonly used methods were the IPCs depot medroxyprogesterone acetate and norethisterone oenanthate, used by 22.1 % of all the women. The oral contraceptive (OC) was used by 4.5% ofthe total sample and only 1.3%
of respondents reported the male condom as their current method. No-one used the female condom. While 17.4 % of respondents under 20 years were using a contraceptive
method, over a third (37.8%) of the teen respondents who had ever been pregnant were using a contraceptive method. Excluding the 211 respondents who were not sexually active, or were pregnant, infertile or menopausal, 28.6% were using IPCs, 5.9% were using the oral contraceptive and 1.7% were using the male condom.
Ofthose who reported using a method (n=252), 94.4% were using a modern method (injectable or oral hormonal contraceptive, male condom, intrauterine contraceptive device [IUD], tuballigation), 3.2% a traditional method and 2.4% substances not registered with the Medicines Control Council for contraceptive use (Table 1.3.6).
Current use of natural family planning methods such as the calendar or rhythm method or the basal body temperature method was not reported. In contrast to the wide spread use of the injectable method (74.2% of women practising contraception), the condom was used by only 4.4% of current users.
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Table 1.3.6 Current contraceptive practice (n=252)
*
Use of a snail's shellISa traditional contraceptive practice which mvolves takmg the cloth or pad used during menses, putting it in the shell of a snail,and digging a hole and burying it. Care has to be taken to prevent it from getting washed away when it rains as it is believed that if it gets washed away the woman following this practice won't be able to conceive (female parent, from focus group discussion)Current method Number of users 0/0
Modern methods 238 94.4
Injectable contraceptive 187 74.2
Oral contraceptive 38 15.1
Male condom 11 4.4
IUD 1 0.4
Tuballigation 1 0.4
Traditional methods 8 3.2
Thigh sex (ukusoma) 3 1.2
Rope 2 0.8
Snail's shell
*
2 0.8Withdrawal 1 0.4
Other methods 6 2.4
Quinine 3 1.2
Essence oflife 2 0.8
Flagyl 1 0.4
..
In the age range 15-19 years, 83.9% of those using a method were using the injectable, whilst only one woman reported the male condom as her current contraceptive method (Table 1.3.7). More women in the 20-24 year age group were using the oral contraceptive compared to other age groups,but OC use was still much lower than IPC use in this age group. In the group of women who were 40 years or older,injectable use was very high (85.7%) and no OCs or condoms were used.
Table 1.3.7 Current contraceptive method by age
AGE GROUP (YEARS)
CURRENT METHOD <20 20-24 25-29 30-34 35-39 40-49
n(%) n(%) n(%) n(%) n(%) n(%)
Injectable contraceptive 26 (84) 55 (69) 62 (73) 25 (86) 13 (65) 6 (86)
Oral contraceptive 3 (10) 17 (21) 13 (15) 3 (10) 2 (10)
o
(0)Male condom 1 (3) 3 (4) 5 (6) 1 (4) 1 (5)
o
(0)Other methods 1 (3) 5 (6) 5 (6) 0 (0) 4 (20) 1 (14)
Total number 31 (100) 80 (100) 85 (100) 29 (100) 20 (100) 7 (100)
All but three teen respondents who had ever been pregnant and were using a
contraceptive method were using the injectable method.The other methods used by teenagers ever pregnant were:oral contraceptives (n=2) and flagyl Cl),which is not a contraceptive and should not be used as such.Amongst students and scholars, 18.4%
were using the injectable and only 1.0% the male condom (Table 1.3.8).
Table 1.3.8 Contraceptive practice of scholars and students (n=201)
CURRENT METHOD SCHOLARS STUDENTS TOTAL
n = 180 (%) n=21 (%) n =201 (%)
No method* 139 (77.2) 13 (61.9) 152 (75.6)
Injectable contraceptive 30 (16.7) 7 (33.3) 37 (18.4)
Oral contraceptive 5 (2.8) 1 (4.8) 6 (3.0)
Male condom 2 (1.1) 0 (0) 2 (1.0)
Other methods 4 (2.2) 0 (0) 4 (2.0)
* Of these,56 werenot sexually active,and 8 were pregnant
Not surprisingly, given the low use of any method other than the injectable, contraceptive practice was very low amongst the non IPC users and discontinued IPC users (Table 1.3.9). Condom use was low amongst women in these two user groups and some
methods, such as quinine and Flagyl,with questionable contraceptive efficacy and safety were used.
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- -
- - - -
Table 1.3.9 Current contraceptive use by IPC user status
Contraceptive use Current Users Previous Users Never Used Total
Current contraceptive use
n=187 n=244 n=417 n=848
% Currently using a contraceptive method 100 11.5 8.9 29.7
(all women)
n=187 n=178 n=272 n=637
% Currently using a contraceptive method 100 15.7 13.6 39.6
(excluding: sexually inactive, pregnant, had hysterectomy,menopausal, infertile) Current contraceptive method
n=187 n=28 n=37 n=252
IPC 187 - - 187
QC - 12 26 38
Male condom - 7 4 11
Female condom - - - -
100 - 1 - 1
Tuballigation - - 1 1
Thigh sex - 1 2 3
Withdrawal - - 1 1
Rope - 1 1 2
Quinine - 2 1 3
Essence oflife - 1 1 2
Snail'sshell - 2 - 2
Flazvl - 1 - 1
1.3.4.2 Reasons for Contraceptive Method Choice
In response to an open-ended question about reasons for choosing the injectable method, the most common reason, given by 35.0% of respondents, was that it was convenient. The method was considered to be convenient since it only has to be used every two or three months, or because one does not have to remember to take it every day as with the oral contraceptive. Nearly a quarter of the injectable users (23.0%) chose this method because it is effective, often making statements such as "its always in my blood" or "it stays in the blood a long time". The third most common reason given for using the injectable was that it was recommended by the clinic health personnel, with 19.7% giving this response.
Some respondents (4.9%) simply stated that the method "suited them", others expressed a
dislike of oral contraceptives because of side effects experienced (4.4%).A few (2.7%) chose the method as it could be used without their partner'sknowledge.
Similar responses were given when injectable users were prompted to respond to each of a list of 10 possible reasons for choosing the injectable method. Almost all (96.3%) the 187 injectable users indicated that they chose this method for convenience, as they only had to return to the clinic every two or three months. Other common responses were that:
it was effective (47.6%); it was recommended at the clinic (37.4%); few problems or side effects were experienced (27.3%); it caused amenorrhoea (23.0%); it was recommended by friends or relatives (21.5%); and it was a method that could be hidden from partners (20.9%).Although not reported in response to the open-ended question,52.9% said that they chose the method because they felt that it was a safe way to prevent pregnancy.
A quarter (25.8%) of the women who were practicing contraception were using a method other than the injectable, and the most common reason for method choice, given by 43.3% in response to an open-ended question, was related to injectable side effects.
Although almost half ofthe women giving this response had used the injectable method before, only 55.6% of these previous injectable users gave this as their reason for current method choice.A few were using a method on the recommendation of their partner (n=4), relatives or friends (n=I), or the health provider (n=2). Six of the women giving this response were using the oral contraceptive and one was using the withdrawal method.Of note is that 7 women were using the condom and 3 were using thigh sex,because these methods were considered to provide protection against both pregnancy and sexually
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transmitted diseases. The remaining condom users indicated that they did not like the side effects of oral contraceptives,or that their partner was often away and a regular method was not needed.