Cultural change beyond adoption dynamics: Evolutionary approaches to the discontinuation of contraception

Journal article

Side effects are one of the most common reasons for contraceptive non-use, particularly in low- and middle-income countries where many women who want to avoid or delay pregnancy do not use contraception. This study investigates women’s side effect experiences, their care-seeking behavior, the information they receive during contraceptive counseling, and how these factors are related to their contraceptive use. Using longitudinal client-exit-interview data from Performance Monitoring for Action, this study includes 3,566 family planning clients in Kenya using hormonal contraception. Clients were interviewed after receiving family planning services and by phone 4-7 months later. I ran multinomial logistic regression models to assess the association between a broad range of side effects and contraceptive use dynamics. To identify individual, community, and health facility correlates of care-seeking for side effects, I specified a multilevel logistic regression model among those who reported side effects. Additionally, I ran a multinomial model to examine the relationship between care-seeking and contraceptive use dynamics. Finally, I fit a multinomial logistic regression to explore the relationship between information received during contraceptive counseling and contraceptive use and whether this relationship differed by side effects experience. Side effects from hormonal contraception were common, often leading to switching or stopping contraception, particularly as the number of side effects increased. Care-seeking for these experiences from a provider was mainly driven by individual and community factors rather than facility-based factors. Women who sought care were more likely to switch methods than continue or stop. Too little information during contraceptive counseling increased the likelihood of stopping contraception compared to receiving a self-perceived adequate amount of information. Additionally, the effect of receiving just enough information varied depending on the presence of side effects. Tailored, high-quality optimal counseling is essential to help clients manage contraceptive side effects, as well-informed clients are more likely to continue contraceptive use. However, side effects still have a significant impact on contraceptive use. Improving strategies for managing side effects and developing new contraceptive options are key to enhancing user experiences and maintaining protection against unintended pregnancies

Authors: Alvergne, A; Stevens, R

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Cambridge University Press
• Journal: Evolutionary Human Sciences
• Volume: 3
• Pages: e13-e13
• Article number: e13
• Publication date: 2021-02-09
• DOI: 10.1017/ehs.2021.8
• EISSN: 2513-843X
• ISSN: 2513-843X
• Language: English
• Keywords: Evolutionary dynamics; Flexibility (engineering); Psychology; Total fertility rate; Population; Economic growth; Family planning; Discontinuation; Demography; Sociology; Economics; Scholarship; Fertility