CONTRACEPTIVE METHOD MIX
1.3.2 INJECTABLE PROGESTOGEN CONTRACEPTIVE PREVALENCE AND USER CHARACTERISTICS
A detailed analysis of the demographic patterns of injectable progestogen contraceptive (Il'C) use is undertaken here, to provide some explanations for the popularity of this method in South Africa. This understanding should inform contraceptive policy for
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service delivery which better suits theneeds of South Africanwomen. Each of the three injectable user categoriesofthe study are described,i.e. those women who were using the injectable contraceptive atthe time ofthe survey;those who were not usingit but had used it previousl y;and those who had neverused it. These three sub-sampleswill be referredto as IPC users (injectable users),previous or discontinued users(those who had used IPCs previously but were not currentusers) and a never-usedgroup (those who had never used IPCs).
1.3.2.1 IPC Prevalence
At the time of the survey, 187 (22.1%) of the 848 women interviewed were using an injectable contraceptive method, either Depo-Provera'"or Nur-Isterate®(Table 1.3.2). Just over halfthe women had used an IPC at some time.
Table 1.3.2 Prevalence of IPC use
IPC Use Status of Respondents N=848 %
Current IPC Users 187 22.1
Discontinued IPC Users 244 28.8
(currently not using IPC's)
Total Ever-Used IPCs 431 50.8
Never-UsedIPCs 417 49.2
1.3.2.2Demographic Characteristics of IPC Users
All the injectable contraceptive users interviewed in the Hlabisasub-district wereZulu- speaking African women. The predominant religions practiced were Zionist (31.5%), Lutheran (19.6%)and Roman Catholic (17.9%).Similarproportions of Roman Catholics had ever used the injectable method (52%used DMPA;51%used NET-EN). Key
demographic characteristics ofIPC users are summarized in the second column of Table 1.3.3 (see sub-section 1.3.3.1 later in this chapter),which also provides comparative demographic data of discontinued users and the never-used group.
Only women in the age range 15 to 49 years were selected into the study. Injectable users' ages ranged from 17 to 49 years,with a mean age of 26.1 (median and mode=25) years. Over three quarters (76.4%) were under 30 years of age, with 13.9% under 20 years (Figure 1.3.1).Of all the under 20 year-olds interviewed, 14.6% were IPC users and 23.9% of all respondents under 30 years were using an IPC. Injectables are thus widely used by young women. A more detailed analysis of the age of injectable users in comparison to discontinued users and the never-used group is provided later in this chapter.
Figure 1.3.1 Age distribution of injectable contraceptive users
35 30 25
20 15
10 5
o
17-19 20-24 25-29 30-34 35-39 Age (years)
40-44 45-49
Most IPC users (77.5%) were in a single-stable relationship and only 13.4% were married by civil, religious, traditional or customary ceremony (Figure 1.3.2). Two women had
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been divorced, and six had been widowed. Four women, who indicated that they were not in any type of relationship, yet were using the injectable contraceptive method, had all lost their partners within the few weeks preceding the interview. Two were recently widowed and the partners of two had recently left the relationship.
Figure 1.3.2 Marital status of injectable contraceptive users
7"10 2"10 13%
I!lMuriOO
• Sable 10mal EJNne
The average household size of IPC users was 8.5 people, with a median of 8, a mode of 7 and a range of2 to 25 people. The average number of women (agedl5 to 49 years) per household was 1.7 (median 2, mode 1, range 1-5).
IPC users were fairly well educated with 75.3% having attained an education level of Grade 8 (8 years of schooling) or higher. However, 70.6% were unemployed or
housewives and 19.8% were scholars or students. Of those employed, in both the formal and informal sector, seven were professionals (teacher or nurse), five were working as semi-skilled workers (clinic assistant, cook or dressmaker), three were involved in sales work, and one was a domestic worker. Most IPC respondents (91.8%) had no personal income and 91.6% reported a household income ofRlOOO per month or less.
1.3.2.3 Reproductive and Contraceptive History ofIPC Users
Table 1.3.4 (see sub-section 1.3.3.2 later in this chapter) provides a summary of the reproductive history and past contraceptive use of IPC users. Only six IPC users had never been pregnant,with 96.8% having been pregnant. The mean age at first pregnancy was reported to be 19.2 years. Of those ever pregnant, the youngest age at first pregnancy was 12 and the oldest was 30, with 7.2% first pregnant when they were under 16 years and 60.2% when they were under 20 years. Only 12 (including the six never pregnant) had no children and the maximum number of living children was seven. Of those who had children (n=175) the average number was 2 (median and mode =1). Nearly halfthe IPC users (48.7%) had one child (Figure 1.3.3). Twenty-eight women reported miscarriages, six of these had miscarried twice; only four women had had children who had died. Of the IPC users under 20 years at the time ofthe survey all but one, a 19 year old, had been pregnant.
Figure 1.3.3 Distribution of numbers of children of injectable contraceptive users
60
l
50
I
40
'*
3020
10
o
5+
Number of children
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The average age at first contraceptive use was 22.3 years with an age range of 16 to 42 years. In most cases IPCs were the first method used. NET-EN was the first method used by 54.0% and DMPA by 36.4%. The oral contraceptive was the first method for 9.1% of the respondents and only one woman first used the male condom.
1.3.2.4 Residential Status
Most ofthe injectable users (98.4%) were, for the purposes of this study, classified as Hlabisa residents, since they slept at their home for at least 4 nights per week and for at least 50% of the time.In contrast, most of their partners did not reside with them, with 88.2% of women married or in a stable relationship reporting that their partners resided elsewhere (i.e. for four nights a week or more,and for more than 50% of the time), and 76.3% of the partners resided out of the Hlabisa sub-district. Hence, few couples were co- habiting. Thirty-two percent of married women's partners resided with them, compared with 8.3% ofthe women in stable relationships. Most partners returned to their partners once a month (31.5%) or 2 to 3 times a month (21.1%). Their locations when they were away were mainly Johannesburg (20.3%), Richards Bay/Empangeni/NselenilUlundi (16.2%),DurbanlPietermaritzburg (10.8%),MtubatubalSt Lucia (10.1%) and
NongomalBuxedeni (7.4%), with 23.0% of partners residing elsewhere in the
H1abisalH1u1u1we area. Only one respondent's partner returned only once a year and he lived in Johannesburg when he was away. Eight respondents could not predict when their partners would return, and in all these cases the partners lived in the Hlabisa sub-district (six) or close by (Mtubatuba or Richard's Bay area).
1.3.3 COMPARISON OF INJECTABLE CONTRACEPTIVE USERS WITH