To be continued: family planning continuation among the urban poor in Senegal, a prospective, longitudinal descriptive study. [version 1; referees: 2 approved]

Abstract

Background: Given the role that continued use of family planning (FP) by current users plays in increasing contraceptive prevalence rates (CPR), this research aims to measure method-specific continuation rates for fixed-site and community-based program interventions and to document reasons for discontinuation. Methods: This research compared discontinuation rates for clients initiating family planning through two types of strategies—services provided at existing health centers that provided regular, ongoing services, and “one-off” outreach services in communities. Data collectors surveyed consenting clients who were initiating a modern method, or reinitiating after a break of at least six months, and conducted a follow up survey after seven months. Results: Long acting reversible contraception (LARC) was more commonly initiated through outreach strategies than through fixed sites. LARC made up 65% of methods initiated through the outreach setting and 47% of those initiated through a fixed-site strategy. Continuation rates varied from 99% for intrauterine devices (IUDs) to 77% for injectables and were very similar between outreach and fixed-site strategies, with the exception of oral contraceptive pills (OCPs). Only 65% of outreach initiators continued using OCPs, compared to 84% of fixed-site initiators. Top reported reasons for discontinuation were side effects and little or no sexual relations. Conclusions: Project interventions allowed most women to continue with their chosen method of FP for the seven-month duration of the study whether initiated through fixed site or outreach strategies, showing promise in helping Senegal to increase its CPR. It is feasible to offer both LARC and short acting methods through outreach strategies. Further research into the sensitivity of demand to the price charged is needed.