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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 33  |  Issue : 1  |  Page : 29-32

Frequency of unmet needs among women in childbearing period attending Quweisna district, Menoufia Governorate, Egypt


1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Family Medicine, Quweisna Family Health Center, Menoufia, Egypt

Date of Submission29-Jun-2019
Date of Decision14-Aug-2019
Date of Acceptance25-Aug-2018
Date of Web Publication25-Mar-2020

Correspondence Address:
Bassma I. M. Morsy
Quweisna, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_211_19

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  Abstract 


Objective
To assess the possible causes of failure of contraceptive methods and women behavior after failure of different methods.
Background
Contraceptive failure contributes to a substantial proportion of unintended pregnancy, particularly in the developed world.
Patients and methods
This descriptive cross-sectional study was conducted on 100 participants in childbearing period aged from 19 to 45 years old with history of failure of contraception or pregnant on top of contraceptive method in the past 3 years. The studied participants were selected from Quweisna Family Health Center (urban area) and Meet Abou-Shikha Family Health Unit (rural area) during the period from the June 1 till the end of September 2017. Participants were assessed through detailed medical, obstetric, and contraceptive history.
Results
Of 100 studied women with history of failure of contraception, intrauterine contraceptive device (IUCD) and the progesterone-only pills had the highest failure rate among the studied groups (28 and 22%, respectively). Most of the participants with progesterone-only pills and combined oral contraceptives (84 and 70.6%, respectively) had a history of missing pills. Besides approximately half of the participants with missing pills referred it to fear of their adverse effects. Moreover, approximately half of the participants with contraceptive failure (57%) suspected that IUCD displacement was the cause of its failure and 53.3% referred the failure of condom to the irregular use owing to husband refusal.
Conclusion
The failure of contraceptive method may be related to misuse either missing of pills owing to fear of adverse effects, displacement of IUCD, or partner refusal of condom.

Keywords: combined oral contraceptives, contraception failure, contraceptive methods, injectables, intrauterine contraceptive device


How to cite this article:
Farahat TM, Shaheen HM, El-Esrigy FA, Morsy BI. Frequency of unmet needs among women in childbearing period attending Quweisna district, Menoufia Governorate, Egypt. Menoufia Med J 2020;33:29-32

How to cite this URL:
Farahat TM, Shaheen HM, El-Esrigy FA, Morsy BI. Frequency of unmet needs among women in childbearing period attending Quweisna district, Menoufia Governorate, Egypt. Menoufia Med J [serial online] 2020 [cited 2020 Aug 15];33:29-32. Available from: http://www.mmj.eg.net/text.asp?2020/33/1/29/281273




  Introduction Top


Unintended pregnancy is a potential hazard for women's life in reproductive ages, including unwanted childbearing, recourse to (potentially unsafe) abortion, and maternal and/or newborn morbidity and mortality[1]. In the developing world, 74 million (30%) unintended pregnancies occur annually, of which a sizable share is owing to contraceptive failure among women using some types of contraceptive method (whether traditional or modern)[2].

To understand the definition of contraceptive failure, it is important to distinguish between typical use and perfect use of a contraceptive method and the failure rates associated with each. Typical use refers to the way a method is actually used by women and their partners (failure owing to inconsistent or incorrect use of the method, or even outright nonuse among individuals who report using it). In contrast, perfect use of a method refers to women and their partners following the exact directions for use (failure of the method to work as expected)[3].

Much of what is known about these rates in developing countries comes from Demographic and Health Survey data. For example, Ali et al.[4] assessed causes and consequences of contraceptive discontinuation using Demographic and Health Survey data from married women in 19 countries. Using single-decrement life tables, they found that median values for contraceptive failures by 12 months were 1.1% for the intrauterine device (IUD), 1.5% for injectables, 5.6% for the pills, 7.6% for the male condom, 15.3% for withdrawal, and 17.4% for periodic abstinence (the rate for sterilization was not assessed). Reported failure rates were lowest for IUD and injectable users, intermediate for pill and condom users, and highest for users of withdrawal or periodic abstinence.

These are some possible risk factors that may lead to failure of contraception: forgetting the pills or taking it at irregular times, especially the progesterone-only pills (POP); some drugs that interfere with the metabolism and the absorption of the pills and hence reduce their effectiveness, such as antidepressants, antihistaminics, tranquilizers and some antibiotics as amoxicillin; persistent vomiting or diarrhea; displacement of the intrauterine contraceptive device (IUCD) or the implanon; forgetting the injectables for more than 2 weeks; rupture of the male or the female condoms; lactational amenorrhea for more than 6 months; and displacement of the vaginal ring, sponge, diaphragm, or the cervical cap[5].

The aim of this study was to assess possible causes of failure of contraceptive methods and women behavior after failure of different methods.


  Patients and Methods Top


This descriptive cross-sectional study was conducted on 100 participants in childbearing period aged from 19 to 45 years old with a history of failure of contraception or pregnant on top of contraceptive method in the past 3 years. The studied participants were selected from Quweisna Family Health Center (urban area) and Meet Abou-Shikha Family Health Unit (rural area). They were selected randomly from 33 family health units affiliated to Quweisna city, Menoufia Governorate, Egypt, during the period from the June 1, 2017 till the end of February 2018.

The sample size was calculated using Raosft online sample size calculator based on the overall failure rate of contraception, which was 10.3%[6], considering the power of the study 80 and 95% confidence interval, and the calculated sample size was 100.

Uncooperative women, women not using contraception, and women with chronic diseases were excluded from the study. Participants were evaluated through predesigned questionnaire, which included questions regarding contraceptive history (currently and previously used contraceptive method); questions regarding occurrence of pregnancy during using the method; questions regarding misuse of contraception (missed pills with oral contraceptive methods, taking pills at irregular times with POP, and delayed injection), questions regarding slippage or rupture of condom; and questions about the response after missing pills or occurrence of pregnancy.

Ethical consideration

All participants were volunteers. All of them signed a written informed consent after explaining to them the aim of study before the study initiation. Approval was obtained from ethical committee in Faculty of Medicine, Menoufia University

Statistical analysis

The data were collected, revised, coded, and statistically analyzed by Statistical Package of Social Science (SPSS) (SPSS Inc., Armonk, New York, USA), version 20 using IBM personal computer.


  Results Top


In the current study, of 100 studied women with history of failure of contraception, IUCD and the POP had the highest failure rate among the studied groups (28 and 22%) respectively. On the contrary, the lowest failure rate was among patches and coitus interruptus (1 and 2%, respectively) [Figure 1].
Figure 1: Failure rate of the different contraceptive methods among the studied participants.

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[Table 1] illustrates that 84 and 70.6% of participants with POP and combined oral contraceptives (COC) failure, respectively, had history of missing pills and that 42.4 and 76.5% of POP and COC users, respectively, called their doctors. Furthermore, most of the participants suspected that missing pills was the cause of occurrence of pregnancy and failure of POP (86.4%) and COC (76.5%). Approximately 68% of POP users went to their family physician after failure, and 64.7% of COC users stopped the pills.
Table 1: Possible causes of failure of progesterone-only pills, combined oral contraceptives, and action of the studied participants toward misuse

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[Table 2] revealed that among 28 participants with failure of IUCD (46.4%) intended to use it again and approximately half of them (57%) suspected that displacement was the cause of failure.
Table 2: Possible causes regarding failure of intrauterine contraceptive device

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[Table 3] and [Table 4] denote that approximately two-thirds of the participants (59.1%) suspected that missing the injection is the cause of occurrence of pregnancy and that 72.7% went to family physician after its occurrence. Moreover, 81.8% of them reported delay for injection with mean times of 1.9 ± 1.2 and mean weeks 4.1 ± 3.1. However, approximately half of the participants (53.3%) referred the failure of condom to the irregular use owing to husband refusal.
Table 3: Possible causes of failure of injectable contraception and action of the studied participants toward misuse

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Table 4: Possible causes of failure of male condom among the studied participants

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  Discussion Top


In the current study, IUCD and the POP had the highest failure rate among the studied groups. On the contrary, the lowest failure rate was among patches and coitus interruptus. This disagreed with Sarvestani et al.[7], who found that the highest failure rate in contraceptive methods was among withdrawal, pills, and condom. Polis et al.[8] denoted that the overall 12-month median failure rate for every 100 women using contraception was 0.6 for implants, 1.4 for IUDs, and 1.7 for injectables. Oral contraceptive pills and condoms had higher failure rates: 5.5 for oral contraceptive pills and 5.4 for male condoms. Withdrawal and periodic abstinence had the highest failure rates: 13.4 for withdrawal and 13.9 for periodic abstinence. However, Sundaram et al.[6] reported that overall, 32% of annual failures occur in the first 3 months of use, and 63% occur in the first 6 months. Users of withdrawal had the highest probability of contraceptive failure: 20% of use episodes ended in a pregnancy within 1 year. The male condom had the next highest probability of failure (13%); the pill and the injectable had failure rates of 7 and 4%, respectively. This difference may be attributed to the lower usage of condom and withdrawal methods in our sample, as only six (6%) and 10 (10%) participants used these methods, respectively, and most of them referred to the refusal of their husbands. Most of the participants with failure reported that missing pills (COC and POP) and injections, displacement of IUCD, and husband refusal for condom are the commonest causes for failure of contraception. Participants with missing pills referred it to fear of their adverse effects. In the study by Al-Mansour et al.[9], it was found that 28.7% of Saudi women used oral contraceptive pills for contraception. Most of the women lacked knowledge about oral contraceptive pills and had a negative attitude toward their use. Although more than three-quarters of the women had some knowledge about what to do if they missed a pill, less than 10% knew exactly what to do. Aryeetey et al.[10] denoted that among all users, 82% thought contraceptives were effective for birth control. However, one-third did not consider modern family planning safe. Approximately 20% indicated their male partner as a barrier, and 65% of users reported at least one adverse effect Savonius et al.[11] found that only 25% of the pills users had no explanation for the failure. Overall, 76.7% of the condom users reported that the condom was broken, had slipped off, or its use had been irregular. The concern about adverse effects was the most common reason for not using safe contraceptives (25%). Peyman et al.[12] also reported that fear of adverse effects of the contraceptives can affect contraceptive usage, and subsequently, the rate of unintended pregnancy, which indicates the fear of adverse effects of pill usage in terms of intention of pregnancy (whether wanted or unwanted). More than 60% of women with both unintended pregnancy and wanted pregnancy believed that pills could lead to neurasthenia, skin blemishes, obesity, and extra hair on body.


  Conclusion Top


The failure of contraception may be related to misuse, that is, either missing of pills owing to fear of adverse effects, displacement of IUCD, or partner refusal of condom. So the family health facilities have a greater role in decreasing the failure rate of contraception by encouraging contraceptive counseling for both partners and monthly follow-up visits.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tsui AO, McDonald-Mosley R, Burke AE. Family planning and the burden of unintended pregnancies. Epidemiol Rev 2010; 32:152–174.  Back to cited text no. 1
    
2.
Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plann 2014; 45:301–314.  Back to cited text no. 2
    
3.
Trussell J, Nelson AL, Cates W, Kowal D, Policar M, Kost K. Contraceptive failure in the United States: a critical review of the literature. Stud Fam Plann 2013; 18:237–283.  Back to cited text no. 3
    
4.
Ali MM, Cleland J, Shah I. Causes and consequences of contraceptive discontinuation: evidence from 60 demographic and health surveys. Geneva: World Health Organization; 2012.  Back to cited text no. 4
    
5.
Haseeb F. Infertility and contraception. Basic gynecology. Egypt: Kalyoub Press; 2007. 183–223.  Back to cited text no. 5
    
6.
Sundaram A, Vaughan B, Kost K, Bankole A, Finer L, Trussell J, et al. Contraceptive failure in the United States: estimates from the 2006–2010 National Survey of Family Growth. Perspect Sex Reprod Health 2017; 49:7–16.  Back to cited text no. 6
    
7.
Sarvestani KA, Ahmadi A, Enayat H, Movahed M. Level and factors related to unintended pregnancy with a brief review of new population policies in Iran. Iran J Public Health 2017; 46:973–981.  Back to cited text no. 7
    
8.
Polis CB, Bradley SE, Bankole A, Onda T, Croft T, Singh S. Typical-use contraceptive failure rates in 43 countries with Demographic and Health Survey data: summary of a detailed report. Contraception 2016; 94:11–17.  Back to cited text no. 8
    
9.
Al-Mansour R, Sabra AA, Hafez AS. Contraception: knowledge, attitudes and practice with special emphasis on contraceptive pills among Saudi Women at Al-Khobar City, Eastern Saudi Arabia. Egypt J Comm Med 2012; 30:1–13.  Back to cited text no. 9
    
10.
Aryeetey R, Kotoh AM, Hindin MJ. Knowledge, perceptions and ever use of modern contraception among women in the Ga East District, Ghana. Afr J Reprod Health 2010; 14:27–32.  Back to cited text no. 10
    
11.
Savonius H, Pakarinen P, Sjöberg L, Kajanoja P. Reasons for pregnancy termination: negligence or failure of contraception? Acta Obstet Gynecol Scand 1995; 74:818–821.  Back to cited text no. 11
    
12.
Peyman N, Hidarnia A, Ghofranipour F, Kazemnezhad A, Oakley D, Khodaee G, et al. Self-efficacy: does it predict the effectiveness of contraceptive use in Iranian women? East Mediterr Health J 2009; 15:1254–1262.  Back to cited text no. 12
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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