'Failed' contraception in a rural South African population.
OBJECTIVE
To investigate whether the free availability of contraception affects the need for termination of pregnancy (TOP).


METHODS
Case-control study.


METHODS
South African rural hospital.


METHODS
Three thousand and ninety-five TOP seekers and 439 non-pregnant controls.


METHODS
Structured questionnaire followed by ultrasonography.


METHODS
Current use or recent discontinuation of contraception and the reason for discontinuation.


RESULTS
Less than one-third (28.6%) of TOP seekers claimed to be using contraception versus 85.0% of controls. Injectable contraception (IC) was preferred by the controls and oral contraception (OC) by TOP seekers (chi 2 = 48.5, p < 0.0001, OR 0.34 (95% confidence interval 0.25, 0.46)). The percentage of discontinuation of hormonal contraception was higher in controls (chi 2 = 6.3, p = 0.012, OR 0.51 (0.31, 0.85)). The reason for discontinuation of hormonal contraception was obtained from 31.2% of TOP seekers and 63.3% of controls; no reason for discontinuation was acknowledged by 30.1% of the former and 6.3% of the latter (chi 2 = 33.4, p < 0.0001, OR 6.40 (3.25, 12.56)). Side-effects of hormonal contraception prompted more discontinuation in the failed-contraception group (chi 2 = 120.5, p < 0.0001, OR 49.4 (21.6, 112.5)). Poor compliance and absence of an acknowledged reason for discontinuing hormonal contraception resulted in 173 unwanted pregnancies.


CONCLUSIONS
In South Africa two main components of women's reproductive health and rights are freely available, namely contraception and TOP. Not using contraception is one of the main causes of unwanted pregnancy. Better education of both service providers and users is needed to improve use, compliance and perseverance with contraception.
van Bogaert
Louis-Jacques
LJ
Department of Obstetrics and Gynaecology, Philadelphia Hospital (MEDUNSA Satellite Campus), Dennilton, Mpumalanga.
D000028:Abortion, Induced / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D003267:Contraception / Q000706:statistics & numerical data; D003268:Contraception Behavior / Q000706:statistics & numerical data; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D011247:Pregnancy / Q000706:statistics & numerical data; D011275:Pregnancy, Unwanted / Q000706:statistics & numerical data; D012423:Rural Health; D013019:South Africa / Q000453:epidemiology; D017211:Treatment Failure; D016387:Women's Health
D003271:Contraceptive Agents, Female