1.1. Background of the study
Contraception allows women, and couples, to determine if and when to have children; and it plays a pivotal role in population control, poverty reduction, and human development (KATHLEEN McNAMEE MB BS, 2013). But when the fail, they result in unintended births which in turn lead to grave consequences for the health and well-being of women and families, particularly in low- and middle-income countries where maternal mortality is high and abortions are often unsafe (SARAH.E.K., 2011).
According to some studies, none adherence is one of the reasons for contraceptive failure and it depends on the methods used. For example, more efficacy was found with male and female sterilization and the long-acting reversible contraceptives, while low efficacy was found with hormonal contraceptives requiring more frequency of administration and consequently more adherence (James Trussell, P. , 2013). Other studies suggest that demographic and Socioeconomic Characteristics have also an impact on the contraceptive failure rate. Subregional factors have been observed in some studies and some other studies also suggested that as a greater proportion of women begin using contraceptives, a greater proportion of women are likely to experience unintended pregnancies via failure (Singh, 2014). In some situation, drug interaction is another reason for contraceptive failure (Shaver, 2002).
Many studies show that contraceptive prevalence continues to increase and that the proportion of unintended pregnancies that result from failure is likely to increase concomitantly, thus, there is a need for more research on the correct use of these contraceptives in order to avoid failure and its consequence. More research is needed in developing countries, where in contrast with developed countries, little is known about contraceptives failure and its consequences (Black, 2010,2002).
This study aims to fill this gap, by evaluating hormonal contraceptive effectiveness in Rwanda, focusing on Gasabo district. Indeed, according to studies, contraceptive prevalence has increased markedly in Rwanda, yet few studies exist about their effectiveness, hence there is an urgent need to fill the gap (SURVEY, 2014-2015).
1.2. Problem statement
Contraceptive methods are highly effective methods of reversible contraception in controlling births (Black A. ,., 1995,2014). But their failure and discontinuations contribute considerably to lead to grave consequences for the health and well-being of women and families, particularly in low- and middle-income countries like Rwanda where maternal mortality is high and abortions are often unsafe.
As the failure rate is very high for such kind of contraceptive, research on this failure rate is needed to improve their effectiveness. There are very a small number of studies about these rates in developing countries, as most information available comes only from Demographic and Health Survey (DHS) data. This study contributes to fill the gap by evaluating the rate failure in one Rwandese district.
1.3. Study Objectives
1.3.1. Broad Objective
This study is mainly aimed to evaluate the effectiveness of hormonal contraceptives methods among women in Gasabo district.
1.3.2. Specific objectives
This research project is specifically aimed:
1. To determine the failure rate of hormonal contraceptives methods among women in Gasabo district.
2. To identify the reasons for discontinuing hormonal contraceptive.
1.4. Research questions
1. What is the failure rate of hormonal contraceptive methods among women in Gasabo district?
2. What are the reasons for failure?
1.5. The significance of the study
This study is mainly intending to evaluate the effectiveness of hormonal contraceptive methods among women in Gasabo district, Kigali city. Thus, we assess the failure, discontinuation rates of the hormonal contraceptive methods and associated reasons among users. Therefore, methods users and health care providers, from this district as well as the whole country will earn the information on hormonal contraception in order to reduce both their failure and discontinuation rates. And yet, the decision-makers will gain the way of overcoming the challenges of the family planning in Rwanda.