Contraceptive knowledge, use and intentions of Malawian women undergoing obstetric fistula repair

Abstract

Objectives: Unintended pregnancy contributes to morbidities, such as obstetric fistula. Furthermore, after fistula repair, women should avoid pregnancy for a year to prevent its breakdown. Our study objective was to evaluate the contraceptive knowledge, practices and intentions of women undergoing obstetric fistula repair at a centre in Malawi.

Methods: This cross-sectional study used a standardised survey to examine the contraceptive knowledge, practices and intentions of women undergoing obstetric fistula repair in Lilongwe, Malawi, between September 2011 and November 2014. Log binomial models were used to examine correlates of prior and planned contraceptive use.

Results: The analysis included 569 women, of whom 61.3% had heard of, and 38.7% had used a modern method of contraception. Women aged 20–49 years, married, with secondary education or higher and with living children were significantly more likely to report prior use of a modern contraceptive method. Of the 354 women who still had reproductive potential (premenopausal women who had not undergone sterilisation) and answered questions on future contraceptive use, less than half (41.6%) planned to use a modern method of contraception after fistula repair. Planned modern contraceptive use was significantly associated with being currently married and having secondary education or higher.

Conclusions: Contraceptive knowledge, prior use and planned future use were low in our study population. To increase contraceptive use among women undergoing obstetric fistula repair, interventions in the postoperative period must seek to increase their family planning knowledge and access to contraceptive methods.

Chinese abstract

目的：意外怀孕会导致产科瘘管之类的疾病。此外, 瘘管修复后, 妇女应避孕一年, 以防止病情加重。我们的研究目标是在马拉维的一个中心对进行产科瘘管修复的妇女的避孕知识, 用途和目的进行评估。

方法：这项横断面研究使用统一的方法调查2011年9月至2014年11月在马拉维利隆圭进行产科瘘管修补术妇女的避孕知识, 用途和目的。采用对数二项模型明确前期使用和计划使用避孕用品的相关性。

结果：共分析了569名女性, 其中61.3％的女性听说过, 38.7％的女性使用过现代避孕方法。年龄在 20-49岁, 已婚, 中等以上文化程度和有子女的女性更有可能使用现代避孕方法。354名仍有生育能力（绝经前未绝育的女性）并回答未来使用避孕用品问题的女性中, 计划在修复瘘管后使用现代避孕方法的女性不到一半（41.6％）。计划使用现代避孕用品与已婚和接受中等以上教育显著相关。

结论：我们研究人群的避孕知识缺乏, 以前使用和计划将来使用避孕用品的水平较低。为了增加接受产科瘘管修补手术的妇女避孕用品的使用, 术后干预措施必须增加计划生育知识以及可获得的避孕方法知识。

Keywords:

• Africa
• contraception
• family planning
• fertility
• Malawi
• obstetric fistula

Acknowledgements

The authors thank the patients and staff at the Freedom from Fistula Care Centre in Lilongwe, Malawi, UNC Project-Malawi, the Lilongwe District Health Management Team, and the following research assistants for their contributions to the study and assistance with recruitment and data collection, entry and cleaning: William Nundwe, Sandra Ngwira, Sella Chisanga, Julia Ryan, Laura Drew and Magdalene Zgambo.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The funding for the implementation of this research study was by the Freedom from Fistula Foundation (Perth, UK); Department of Obstetrics and Gynecology, University of North Carolina (Chapel Hill, NC); Doris Duke Charitable Foundation (New York, NY); University of North Carolina, Johns Hopkins University, Morehouse School of Medicine and Tulane University NIH Fogarty International Center (Bethesda, MD) (grant 5R25TW009340). Use of the REDCap database was funded by grant 1UL1TR001111 from the North Carolina–Chapel Hill Clinical and Translational Science Award program of the Division of Research Resources. Dr Kopp’s research efforts were supported by National Institute of Child Health and Human Development training grant 5T32 HD075731-01 to the University of North Carolina–Chapel Hill.