title: Timeliness of contraceptive reinjections in South Africa and its relation to unintentional discontinuation.
abstract: BACKGROUND
  Research examining hormonal injectable contraceptive continuation has focused on clients' intentional discontinuation. Little attention, however, has been paid to unintentional discontinuation due to providers' management of clients who would like to continue use but arrive late for their scheduled reinjections.
  
  
  METHODS
  A cross-sectional survey of 1,042 continuing injectable clients at 10 public clinics was conducted in South Africa's Western and Eastern Cape provinces. Bivariate logistic regression analyses were used to identify associations between specific variables and the likelihood of receiving a reinjection, among clients who returned to clinics late but within the two-week grace period for reinjection.
  
  
  RESULTS
  Of 626 continuing clients in the Western Cape, 29% were up to two weeks late and 25% were 2-12 weeks late for their scheduled reinjection; these proportions among 416 continuing clients in the Eastern Cape were 42% and 16%, respectively. Only 1% of continuing clients in the Western Cape who arrived during the two-week grace period did not receive a reinjection; however, 36% of similar clients in the Eastern Cape did not receive a reinjection. Among late clients in the Eastern Cape who did not receive a reinjection, 64% did not receive any other method. Few variables were significant in bivariate analyses; however, certain characteristics were associated with receiving reinjections among late clients in the Eastern Cape.
  
  
  CONCLUSIONS
  It is common for clients to arrive late for reinjections in this setting. Providers should adhere to protocols for the reinjection grace period and have a contraceptive coverage plan for clients arriving past the grace period to reduce clients' risk of unintentional discontinuation and unintended pregnancy.
authors.affiliation: Health Services Research Division, Family Health International (FHI), Research Triangle Park, NC, USA. jbaumgartner@fhi.org
authors.forename: Joy Noel
authors.initials: JN
authors.lastname: Baumgartner
authors.forename: Chelsea
authors.initials: C
authors.lastname: Morroni
authors.forename: Regina Dlakulu
authors.initials: RD
authors.lastname: Mlobeli
authors.forename: Conrad
authors.initials: C
authors.lastname: Otterness
authors.forename: Landon
authors.initials: L
authors.lastname: Myer
authors.forename: Barbara
authors.initials: B
authors.lastname: Janowitz
authors.forename: John
authors.initials: J
authors.lastname: Stanback
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Buga
mesh_terms: D000293:Adolescent; D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007267:Injections; D033182:Intention; D010349:Patient Compliance / Q000523:psychology*; D013019:South Africa
chemical_list: D003271:Contraceptive Agents, Female