Adherence to Modern Contraceptives Among Female Refugee Adolescents in Northern Uganda: A Prospective Single Cohort Study

Abstract

Ritah Bakesiima,1,2 Kristina Gemzell-Danielsson,2,3 Jolly Beyeza-Kashesya,4 Amanda Cleeve,2,3,5 Elin C Larsson,2,3,6 Rose Chalo Nabirye7 1Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; 2Department of Women’s and Children’s Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Stockholm, Sweden; 3WHO Collaborating Centre, Division of Women’s Health, Karolinska University Hospital, Stockholm, Sweden; 4Department of Obstetrics and Gynaecology, Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda; 5Department of Women´s Health, South General Hospital, Stockholm, Sweden; 6Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; 7Department of Nursing, Faculty of Health Sciences, Busitema University, Mbale, UgandaCorrespondence: Ritah Bakesiima, Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda, Email [email protected]: Contraceptive adherence is the current and consistent use of a contraceptive method as prescribed by a health worker or family planning provider so as to prevent pregnancy. Globally, adherence is lowest among adolescents. This has greatly contributed to the high burden of adolescent pregnancies. Adherence and reasons for discontinuation among refugee adolescents are poorly understood. The aim of this study was to determine the rates and predictors of adherence to modern contraceptives among female refugee adolescents in northern Uganda.Methods: This was a prospective single cohort study, nested into a randomised controlled trial (RCT) assessing the effect of peer counselling on acceptance of modern contraceptives. The RCT was conducted among female refugee adolescents in Palabek refugee settlement, northern Uganda. The study involved 272 new starters of modern contraceptives who were followed up for six months from May 2019 to January 2020. The outcome was measured at one, three, and six months after receiving a contraceptive method, and the predictors of adherence were determined using Generalised Estimating Equations (GEE). Data were analysed using STATA version 14.0.Results: Adherence rates were low and reduced over time. By the end of the six months, only 44% of the participants were using a contraceptive method. Participants using long-acting reversible contraceptives (LARC) were more likely to adhere compared to those who were using short-acting reversible contraceptives (SARC) (OR: 3.37, 95% CI: 1.914– 5.937, p< 0.001).Conclusion: Adherence to modern contraceptives was low, leaving adolescents at risk of unintended pregnancies. Participants using LARC were more likely to adhere than those using SARC. Interventions addressing fear of side effects and partner prohibition should be studied and implemented to enable adherence to modern contraceptives.Keywords: contraceptive adherence, contraceptive discontinuation, adolescents, refugees, teenage pregnancy

Keywords

• contraceptive adherence
• contraceptive discontinuation
• adolescents
• refugees
• teenage pregnancy