title: Contraceptive use among women with chronic medical conditions and factors associated with its non-use in Malaysia.
abstract: BACKGROUND
  Women with chronic medical conditions are at higher risk of adverse pregnancy outcomes, which may be minimized through optimal preconception care and appropriate contraceptive use. This study aimed to describe contraceptive use among women with chronic medical conditions and factors associated with its non-use.
  
  
  METHODS
  This study used cross-sectional data from a family planning survey among women with chronic medical conditions conducted in three health facilities in a southern state of Malaysia. A total of 450 married women in reproductive age (18-50 year) with intact uterus, and do not plan to conceive were analysed for contraceptive use. Both univariate and multivariate analysis was conducted to identify factors associated with contraceptive non-use among the study participants.
  
  
  RESULTS
  A total of 312 (69.3%) of the study participants did not use contraceptive. Contraceptive non-use was highest among the diabetics (71.2%), connective tissue disease patients (68.6%) and hypertensive patients (65.3%). Only 26.3% of women with heart disease did not use contraceptive. In the multivariate analysis, contraceptive non-use was significantly more common among women who received their medical treatment in the health clinics as compared to those who received treatment in the hospital (adjusted odds ratio [OR]=1.75, 95% confidence interval [CI]: 1.09, 2.79), being in older age group of 41-50 year (adjusted OR=2.31, 95% CI: 1.19, 4.48), having children (adjusted OR=4.57, 95% CI: 1.66, 12.57) and having lower education (adjusted OR=2.87, 95% CI: 1.43, 5.77).
  
  
  CONCLUSIONS
  About two-third of women with chronic medical conditions who needed contraceptive did not use them despite the higher risk of pregnancy related complications. The high unmet need warrant an effective health promotion programme to encourage the uptake of contraceptives especially targeting women of older age group, low education and those who received their medical treatment at health clinics.
authors.affiliation: Department of Community Health, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia. rosliza72@yahoo.co.uk
authors.forename: Rosliza Abdul
authors.initials: RA
authors.lastname: Manaf
authors.forename: Irmi Zarina
authors.initials: IZ
authors.lastname: Ismail
authors.forename: Latiffah A
authors.initials: LA
authors.lastname: Latiff
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002908:Chronic Disease / Q000453:epidemiology*; D003267:Contraception / Q000379:methods* / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008875:Middle Aged; D012959:Socioeconomic Factors; D055815:Young Adult