Even in countries where contraceptive prevalence is high, substantial proportions of women who want to space or stop childbearing discontinue their method within a year of beginning use, exposing themselves to the risk of unintended pregnancy if they do not adopt another method. In the lead article in this issue, Holly McClain Burke and Constance Ambasa-Shisanya report on the evaluation of a radiobased communications campaign designed to improve continuation among first-time users of the injectable in Kenya [see article]. Using data from an intervention district and a comparison district in an adjusted hazard model that controlled for differences in preintervention discontinuation rates, the researchers found no significant difference between districts in the change in the rate of discontinuation pre- and postintervention. Having method-related side effects or health concerns was associated with discontinuation in both districts, while other factors differed between districts. The authors comment that addressing method-related side effects and health concerns is essential to improved continuation of the injectable.
Studies on the timing of sexual debut have tended to focus on individual characteristics without taking into account the potential influence of other variables. Using survey data collected from more than 8,100 11–17-year-olds in 160 schools in Nyanza, Kenya, Eric Tenkorang and Eleanor Maticka-Tyndale found associations with individual, school and community characteristics [see article]. The risk of early sexual debut rose with the number of sources from which youth had felt pressure to engage in sex and with the number of AIDS myths endorsed, and was higher among youth who perceived that they had a small or (among females only) moderate chance of contracting HIV. The risk was negatively associated with abstinence self-efficacy among males, and was lower among males and females who lived in a community where AIDS deaths were publicly acknowledged, where the Primary School Action for Better Health program had been implemented, and where abstinence was the primary AIDS prevention message conveyed to youth.
Since the introduction of dedicated emergency contraceptive pills in the mid-1990s, there has been little research into awareness and use of the method in developing countries [see article]. Using DHS data collected from 45 countries between 2001 and 2010, Tia Palermo and colleagues found that the proportion of women who had heard of emergency contraceptive pills was highest in Colombia (66%) and Ukraine (49%) and lowest in Chad (2%) and Timor-Leste (3%). Among sexually experienced women, the proportion who had ever used the method was highest in Colombia (12%) and lowest in Chad (<0.1%). The odds of having heard of or having used it generally increased with wealth. Although the relationship between marital status and awareness of emergency contraceptive pills varied by region, never-married women were more likely than married women to have used the method in countries where significant differences existed.
In Burkina Faso, as in many low-income countries, postpartum women generally wait to adopt a contraceptive method until they have resumed sexual intercourse or their menses have returned [see article]. Traditional practices of postpartum abstinence and breast-feeding delay these events. Clémentine Rossier and Jacqueline Hellen used qualitative data to describe the obstacles women face in making the transition from traditional practices to family planning methods. The main difficulties in the transition were husbands’ refusal to refrain from unprotected sex and family planning providers’ requirement that amenorrheic women have urine pregnancy tests, which are expensive, or come back when they have their period.
Also in This Issue
In a special report, Jane Bertrand and colleagues describe an innovative use of mapping technology to increase contraceptive availability in Kinshasa, Democratic Republic of the Congo [see article]. After identifying all health facilities and pharmacies in Kinshasa that offered at least one contraceptive method, the authors surveyed the sites to determine how many and which methods were available, the number of staff with recent family planning training and whether the site had a basic information system to track contraceptive stock and distribution; 44% of sites met all three criteria. At the time of the survey, a geographic reading was taken using a global positioning system. With interactive mapping, the location of each site and its characteristics can be displayed, showing which areas of Kinshasa need programming to improve access and quality of services.