Choice and factors associated with contraceptive use among women aged 40 years or more at Moi Teaching and Referral Hospital, Eldoret - Kenya

Abstract

Background: Women aged over 40 years old are perimenopausal which is a transition phase marked with symptoms due to hormonal fluctuations, signaling the end of fertility. Though fertility is reduced, pregnancy can occur associated with adverse maternal-fetal outcomes than the younger women. Pregnancies are further complicated by comorbidities such as cardiovascular disease and malignancies prevalent in these women. Therefore, effective contraceptive is necessary until menopause to avert unintended pregnancies. They have unmet need for contraception and this study will assess the factors affecting their contraceptive use. Objective: To determine the proportion of contraception use, choice, as well as factors influencing contraception utilization among women aged forty years or more at Moi Teaching and Referral Hospital (MTRH). Methods: A cross-sectional study among 359 women aged 40-55 years attending specialist outpatient clinics at MTRH from January to December 2020. The outpatient clinics were stratified into 5 major clinical departments (Internal Medicine, Surgery, Obstetrics and Gynecology, General Oncology and Psychiatry) and proportionate sample allocated for each clinic. Systematic sampling was used to select every tenth eligible woman while interviewer administered questionnaire was used to collect sociodemographic, clinical and reproductive history as well as contraception use and choice. Descriptive statistical techniques were used to describe the study participants, while Pearson Chi Square and Fisher‟s exact tests were used to test the association between predictor variables and contraceptive use. Logistic regression was used to control for confounders and adjusted odds ratios computed at 95% confidence interval. Results: The mean age of the study participants was 44.8 (±3.7) years. Majority were aged between 40 to 44 years, 339 (94.4%) had a minimum of primary level of education and 352 (98.1%) had given birth before. The overall proportion of contraception use was 44.6% (n=160), with almost equal proportions 73 (45.6%) using modern hormonal and 75 (46.9%) on non-hormonal contraception methods. The most used contraceptives were Depot Medroxy Progesterone Acetate (DMPA) at 37 (23.1%) and bilateral tubal ligation at 36 (22.5%). Women aged 40-44 years were more likely (AOR=1.243; 95% CI: 0.900, 1.718) to use contraception compared to those aged 45-49 years and nearly twice as likely (AOR= 1.767; 0.846, 3.689) as those aged fifty years or more. Being multiparous (p=0.003) and married (p=0.005) were significantly associated with contraceptive use. Being Catholic (p=0.013), desiring to conceive (p=0.003) and having premenopausal symptoms (p<0.001) were significant barriers to contraception. About half (51%) of participants who did not use any form of contraception cited health concerns. Hypertensive (p=0.013) and those with cardiac disease (p=0.008) significantly used non-hormonal contraceptives. Conclusion: Less than half (44.6%) of women aged 40 years or more used contraception. Majority of them opted for DMPA and bilateral tubal ligation. Being 40-44 years, married and multiparous were significantly associated with contraceptive use. Significant barriers to contraception were being catholic, desiring to conceive and having premenopausal symptoms. Women with heart disease and hypertension significantly used modern nonhormonal contraceptives. Recommendations: There is need to improve uptake of contraceptives by women older than 40 years by addressing barriers to contraception; and counselling those with health-related barriers to the availability of safe contraceptives. Integration of contraception services during patient visits at the outpatient clinics or referral to family planning clinics to improve uptake. A community study using mixed methods can further explore factors affecting contraceptive utilization among these women.