Sexual behaviour and risk compensation among single women of reproductive age using hormonal contraception in Zambia

Abstract

Objective

Developing countries have seen an increase in the use of hormonal contraception due to its high efficacy in preventing pregnancy. Our study assessed risk compensation among single women of reproductive age using hormonal contraception.

Methods

The study used data from a nationally representative, cross-sectional sample of the 2018 Zambia Demographic and Health Survey (DHS). Study participants (N = 2151) were single, sexually active women aged 15–49 years, of whom 595 were using hormonal contraception.

Results

Hormonal contraception was used by 26% of participants, 81% of whom reported they had not used a condom every time they had sexual intercourse (p < .001). Sexually transmitted infections (STIs) were reported in 4% of hormonal contraceptive users, compared with 2% of non-hormonal contraceptive users (p = .036). The odds of condom use at each occurrence of sexual intercourse were lower for: hormonal contraceptive users (adjusted odds ratio [OR] 0.62; 95% confidence interval [CI] 0.48, 0.80); women aged 15–19 years (adjusted OR 0.62; 95% CI 0.36, 1.08) and 20–24 years (adjusted OR 0.56; 95% CI 0.33, 0.95); women with no education (adjusted OR 0.33; 95% CI 0.16, 0.69) and primary education (adjusted OR 0.62; 95% CI 0.42, 0.94); women in the low wealth quintile (adjusted OR 0.46; 95% CI 0.36, 0.61); and women who had one or more children (adjusted OR 0.59; 95% CI 0.45, 0.77).

Conclusion

Lack of knowledge about hormonal contraception predisposes women to sexual risk behaviour. As hormonal contraception is very effective in preventing unwanted pregnancy, and condoms are effective in reducing the risk of STI transmission, the use of both (dual protection) should be encouraged.

摘要

目标:由于激素避孕在预防怀孕方面的高效性, 发展中国家激素避孕的使用有所增加。我们的研究评估了使用激素避孕的育龄单身女性的风险补偿。

方法:该研究使用了2018年赞比亚人口与健康调查(DHS)中具有全国代表性的横断面样本数据。研究参与者(N =2151)是15-49岁的单身性活跃女性, 其中595人使用激素避孕。

结果:26%的受试者使用激素避孕, 其中81%的受试者报告说他们没有在每次性交时使用避孕套(p < .001)。4%的激素类避孕药使用者报告了性传播感染, 而非激素类避孕药使用者报告了性传播感染为2%(p .036)。每次性交时使用避孕套的几率较低的有:激素避孕药使用者(调整后的比值比[OR]0.62；95%置信区间[CI] 0.48, 0.80)；15-19岁的女性(调整后OR 0.6295%置信区间0.36, 1.08)和20–24岁之间的女性(调整后或0.56；95% CI 0.33, 0.95)；没有受过教育的妇女(调整后的OR为0.33；95%置信区间0.16, 0.69)和初等教育(调整后OR 0.6295% CI 0.42, 0.94)；五分之一的低财富的妇女(调整后OR 0.4695% CI 0.36, 0.61)；和有一个或多个孩子的妇女(调整后的or为0.59；95%置信区间0.45, 0.77)。

结论:缺乏关于激素避孕的知识使女性更容易出现风险性行为。由于激素避孕在预防意外怀孕方面非常有效, 避孕套在降低性传播感染传播风险方面也很有效, 因此应鼓励两者兼施(双重保护)。

Keywords:

• Condom use
• hormonal contraception
• sexual risk behaviour
• risk compensation
• sexually transmitted infections

Acknowledgements

We wish to thank the Zambia Central Statistics Office and the DHS Program for granting permission to use their data. We also thank the dissemination department and DHS Program data archivist for their quick response to our request.

Author contributions

All authors contributed to the data analysis and to drafting or revising the article. All authors gave their final approval of the version to be published and agreed to be accountable for all aspects of the work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The 2018 Zambia DHS datasets can be obtained from the DHS Program (ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA) or from the Zambia Statistics Agency (P. O. Box 31908, Lusaka, Zambia).

Additional information

Funding

The study received no funding as it used secondary data from the Zambia DHS.