- Email: [email protected]
Late initiation of contraception among unmarried, less-educated postpartum women in Kenya
Abstracts / Contraception 88 (2013) 433–473 encourage men to seek additional partners or wives. These themes did not vary by HIV status. Conclusions: Complex relationship dynamics and gender norms are implicated in family planning decision-making among couples. Covert contraceptive use was a prominent theme among interviewed couples, illustrating both women’s agency and vulnerability. Efforts to involve men in family planning should focus on discussions around men’s concerns relating to contraception and female sexuality, while supporting women’s autonomy regarding contraceptive choices.
P36 LATE INITIATION OF CONTRACEPTION AMONG UNMARRIED, LESS-EDUCATED POSTPARTUM WOMEN IN KENYA Drake A University of Washington, Seattle, WA, USA Unger J, Kinuthia J, Matemo D, John-Stewart G Objectives: To measure uptake and timing of postpartum contraception initiation and identify correlates of contraceptive use among HIV-1-negative Kenyan women. Methods: HIV-1-negative women in rural Western Kenya were enrolled during pregnancy and followed for 9 months postpartum. Demographics and contraceptive data were collected at enrollment and prospectively. Analyses were restricted to women completing the study at 9 months postpartum. Cox regression was used to identify factors associated with contraceptive use. Results: Among 559 women, median age was 23 years (interquartile range 19–27), 453 (81%) were married, and 356 (63%) used modern methods of contraception by 9 months postpartum. Median time to contraceptive initiation was 3.3 months, and was longer among unmarried women than married women (5.6 vs. 3.1 months, p=.006). Among 316 women using contraception at 9 months postpartum, most used Depo-Provera (55%), followed by oral contraceptives (15%), implants (15%), condoms (13%) and tubal ligations (1%); 2% reported dual methods (condom and Depo-Provera). Married women were 1.85 times as likely as unmarried women to use contraceptives (95% CI 1.37– 2.52, pb.0001). Higher education was also associated with contraceptive use (p=.004). Maternal age, partner age and parity were not associated with contraceptive use. Conclusions: Contraceptive use was low among postpartum women and higher than national Kenyan estimates. Unmarried and less-educated women initiated contraception late during the postpartum period, underscoring the need for counseling for these women, who may be particularly at risk for unintended pregnancy. Effective strategies to improve contraceptive uptake, and use of dual methods, are needed for postpartum women.
P37 CONTRACEPTIVE USE AND SEXUAL HEALTH BEHAVIORS AMONG NEWLY-DIAGNOSED HIV-POSITIVE SOUTH AFRICAN WOMEN AND MEN Blanchard K Ibis Reproductive Health, Cambridge, MA, USA Roberts S, Ramjee G, Lince N, Dawad S, Kelvin E, Hoffman S Objectives: To assess the reproductive health needs of women and men at risk of or newly diagnosed with HIV. Methods: We assessed contraceptive use, sexual behavior and STI history among women and men newly-diagnosed as HIV positive. Participants were recruited from three public-sector clinics in Durban, South Africa, into an 8-
449
month prospective cohort study. Participants completed a baseline interview within 30 days of their diagnosis. Results: In preliminary analysis of data from 233 women and 99 men (total planned n= 463), the male condom was the most common contraceptive (women 53.0%, men 45.5%), followed by injectables (women 33.6%, men 22.2%). No women and 5.1% of men reported using oral contraceptives. Few reported female sterilization (women 2.2%, men 2.0%), male sterilization (women 0.9%, men 0%) or IUD use (women 0.9%, men 0%). Majorities of women (67.8%) and men (56.0%) reported unprotected vaginal sex with their regular partner in the past 3 months. Some 42.4% of women and 38.1% of men disclosed their HIV-positive status to their regular partner, but 77.6% of women and 38.1% of men did not know their regular partner's status. In the past year, 24.9% of women and 35.4% of men reported an STI, and 19.3% of women obtained a pap smear. Conclusions: Women and men in this cohort reported frequent unprotected sex and infrequent use of the most effective contraceptive methods. Family planning and STI prevention and diagnosis should be integrated into HIV prevention, care and treatment to meet the sexual and reproductive health needs of at-risk, newly diagnosed HIV-positive women and men.
P38 WHAT IS THE BENEFIT OF 2523 VASECTOMIES? Shattuck D FHI 360, Durham, NC, USA Bristow H, Wesson J, Nsengiyumva T, Kagabo L, Zan T, Sokal D, Ngabo F Objectives: To characterize the benefits of vasectomy in Rwanda in terms of couple-years of protection (CYP) and averted pregnancies, maternal deaths and infant deaths. We also aim to estimate the potential size of the vasectomy market in Rwanda, and the number of procedures needed to reach levels of prevalence that would fully integrate vasectomy as a family planning option. Methods: In February 2010–December 2012, the Rwanda Ministry of Health delivered 2523 vasectomies. We estimated current benefits of vasectomy using service statistics, Demographic and Health Survey (DHS) data, USAID contraceptive impact factors and costing data (service delivery and commodity costs). We used DHS data to estimate market size and also to calculate the number of vasectomies needed to reach 0.5–2% of the target population. Results: The 2523 vasectomies translated into 25 230 CYP and averted 6308 pregnancies, 21 maternal deaths and 394 infant deaths. Estimated implementation cost was $45 212. To achieve the same number of CYP with other methods requires much greater expenditure of resources: 100 920 Depo Provera injections ($182 161), 378 450 oral pill cycles ($191 293) or 6635 Jadelle implants ($229 921). Using age distributions of current clients, we estimated the target market of future vasectomy clients to be 160 000 men. Some 11 150 new vasectomies are needed to achieve and maintain 1% prevalence by 2023. Conclusions: A small number of vasectomies can complement existing female-controlled family planning methods, adding to efforts to reduce the total fertility rate, increase CYP and achieve Millennium Development Goals 4 and 5. Clearly defining the target market of potential vasectomy clients can provide attainable goals for scale-up initiatives.
P39 ENHANCING CONTRACEPTIVE OPTIONS WITHIN THE MICROBICIDE TRIALS NETWORK IN AFRICA Chappell C University of Washington, Seattle, WA, USA Bunge K, Singh D
P36 LATE INITIATION OF CONTRACEPTION AMONG UNMARRIED, LESS-EDUCATED POSTPARTUM WOMEN IN KENYA Drake A University of Washington, Seattle, WA, USA Unger J, Kinuthia J, Matemo D, John-Stewart G Objectives: To measure uptake and timing of postpartum contraception initiation and identify correlates of contraceptive use among HIV-1-negative Kenyan women. Methods: HIV-1-negative women in rural Western Kenya were enrolled during pregnancy and followed for 9 months postpartum. Demographics and contraceptive data were collected at enrollment and prospectively. Analyses were restricted to women completing the study at 9 months postpartum. Cox regression was used to identify factors associated with contraceptive use. Results: Among 559 women, median age was 23 years (interquartile range 19–27), 453 (81%) were married, and 356 (63%) used modern methods of contraception by 9 months postpartum. Median time to contraceptive initiation was 3.3 months, and was longer among unmarried women than married women (5.6 vs. 3.1 months, p=.006). Among 316 women using contraception at 9 months postpartum, most used Depo-Provera (55%), followed by oral contraceptives (15%), implants (15%), condoms (13%) and tubal ligations (1%); 2% reported dual methods (condom and Depo-Provera). Married women were 1.85 times as likely as unmarried women to use contraceptives (95% CI 1.37– 2.52, pb.0001). Higher education was also associated with contraceptive use (p=.004). Maternal age, partner age and parity were not associated with contraceptive use. Conclusions: Contraceptive use was low among postpartum women and higher than national Kenyan estimates. Unmarried and less-educated women initiated contraception late during the postpartum period, underscoring the need for counseling for these women, who may be particularly at risk for unintended pregnancy. Effective strategies to improve contraceptive uptake, and use of dual methods, are needed for postpartum women.
P37 CONTRACEPTIVE USE AND SEXUAL HEALTH BEHAVIORS AMONG NEWLY-DIAGNOSED HIV-POSITIVE SOUTH AFRICAN WOMEN AND MEN Blanchard K Ibis Reproductive Health, Cambridge, MA, USA Roberts S, Ramjee G, Lince N, Dawad S, Kelvin E, Hoffman S Objectives: To assess the reproductive health needs of women and men at risk of or newly diagnosed with HIV. Methods: We assessed contraceptive use, sexual behavior and STI history among women and men newly-diagnosed as HIV positive. Participants were recruited from three public-sector clinics in Durban, South Africa, into an 8-
449
month prospective cohort study. Participants completed a baseline interview within 30 days of their diagnosis. Results: In preliminary analysis of data from 233 women and 99 men (total planned n= 463), the male condom was the most common contraceptive (women 53.0%, men 45.5%), followed by injectables (women 33.6%, men 22.2%). No women and 5.1% of men reported using oral contraceptives. Few reported female sterilization (women 2.2%, men 2.0%), male sterilization (women 0.9%, men 0%) or IUD use (women 0.9%, men 0%). Majorities of women (67.8%) and men (56.0%) reported unprotected vaginal sex with their regular partner in the past 3 months. Some 42.4% of women and 38.1% of men disclosed their HIV-positive status to their regular partner, but 77.6% of women and 38.1% of men did not know their regular partner's status. In the past year, 24.9% of women and 35.4% of men reported an STI, and 19.3% of women obtained a pap smear. Conclusions: Women and men in this cohort reported frequent unprotected sex and infrequent use of the most effective contraceptive methods. Family planning and STI prevention and diagnosis should be integrated into HIV prevention, care and treatment to meet the sexual and reproductive health needs of at-risk, newly diagnosed HIV-positive women and men.
P38 WHAT IS THE BENEFIT OF 2523 VASECTOMIES? Shattuck D FHI 360, Durham, NC, USA Bristow H, Wesson J, Nsengiyumva T, Kagabo L, Zan T, Sokal D, Ngabo F Objectives: To characterize the benefits of vasectomy in Rwanda in terms of couple-years of protection (CYP) and averted pregnancies, maternal deaths and infant deaths. We also aim to estimate the potential size of the vasectomy market in Rwanda, and the number of procedures needed to reach levels of prevalence that would fully integrate vasectomy as a family planning option. Methods: In February 2010–December 2012, the Rwanda Ministry of Health delivered 2523 vasectomies. We estimated current benefits of vasectomy using service statistics, Demographic and Health Survey (DHS) data, USAID contraceptive impact factors and costing data (service delivery and commodity costs). We used DHS data to estimate market size and also to calculate the number of vasectomies needed to reach 0.5–2% of the target population. Results: The 2523 vasectomies translated into 25 230 CYP and averted 6308 pregnancies, 21 maternal deaths and 394 infant deaths. Estimated implementation cost was $45 212. To achieve the same number of CYP with other methods requires much greater expenditure of resources: 100 920 Depo Provera injections ($182 161), 378 450 oral pill cycles ($191 293) or 6635 Jadelle implants ($229 921). Using age distributions of current clients, we estimated the target market of future vasectomy clients to be 160 000 men. Some 11 150 new vasectomies are needed to achieve and maintain 1% prevalence by 2023. Conclusions: A small number of vasectomies can complement existing female-controlled family planning methods, adding to efforts to reduce the total fertility rate, increase CYP and achieve Millennium Development Goals 4 and 5. Clearly defining the target market of potential vasectomy clients can provide attainable goals for scale-up initiatives.
P39 ENHANCING CONTRACEPTIVE OPTIONS WITHIN THE MICROBICIDE TRIALS NETWORK IN AFRICA Chappell C University of Washington, Seattle, WA, USA Bunge K, Singh D