Barriers and opportunities to effective contraceptive management in Bangladesh

Building on the move to examining contraceptive use dynamics this study examines two areas of contraceptive management, the adoption of a method postpartum and contraceptive discontinuation due to side effects. The study focused on adoption postpartum, as it is an ideal time period in which to examine the timing of adoption. The return of menstruation postpartum provides the indicator of risk to women and their reaction to this was categorised into effective and ineffective adoption. The focus of the study on side effects resulted due to the high prevalence of hormonal contraceptive method in Bangladesh associated with a high rate of discontinuation due to side effects and a lack of information on why women discontinue hormonal contraceptive use due to side effects. The descriptive analysis of the postpartum adoption data indicates that the return of menstruation acts as a trigger (Salway, 1996) to women to adopt a contraceptive method. Of those who adopted postpartum, 52.7% of women in 1993/94 and 64.9% in 1996/97 adopted in the month that they reported menstruation returning. This result has great implications for postpartum contraceptive policy in Bangladesh, a policy that promotes the adoption at 40 days postpartum, which is many cases is long before menstruation returns. In the statistical modelling of postpartum adoption, multinomial models were used, the categories being non-adoption, ineffective adoption and effective adoption. The models found that the most significant factors affecting adoption postpartum were education, discussion with husband and division of residence. The side effects component of this study used both quantitative and qualitative techniques. The statistical modelling found the factors most associated with discontinuation were related to the motivation of the woman; literacy was also found to be related to discontinuation due to method-related reasons, including side effects and health concerns. It is likely that more literate women are better able to switch method and hence their greater likelihood of discontinuation due to method-related reasons.