Community and health facility influences on contraceptive method choice in the Eastern Cape, South Africa

Type Journal Article - International family planning perspectives
Title Community and health facility influences on contraceptive method choice in the Eastern Cape, South Africa
Author(s)
Publication (Day/Month/Year) 2008
Page numbers 62-70
URL http://repository.up.ac.za/bitstream/handle/2263/7592/Stephenson_Community(2008).pdf?sequence=1
Abstract
CONTEXT: Although a growing number ofstudies have examined how community factorsinfluence contraceptive use,few have explored how such factors affectmethod choice. METHODS: Data fromthe 1998 South AfricaDemographic andHealth Survey and the 1998 Eastern Cape Facility Survey were used to examine community and health facility influences on themethod choices of 1,165 women aged 15–49 who lived in the Eastern Cape.Relative risk ratiosfrommultilevelmultinomialmodels assessed howmethod choice varied between communities. RESULTS: The likelihood of using the pill or amore permanentmethod ratherthan the injection rose with the proportion of women in a community who controlled their earnings(risk ratios,3.2 and 3.8,respectively).In communities with higher proportions of females with only a primary education,women were lesslikely to use the pill instead ofthe injection (0.1).Higher doctorstaffing levels were associated with a greaterlikelihood of using the pill or amore permanentmethod (1.5 and 1.4),and havingmore expiredmethodsin stock was associated with increased use of amore permanentmethod (2.1).Several facility factors were associated with a decreased likelihood of using the pillrather than the injection:higher numbers of community health workersin an area and higher numbers of facility nurses who had received training onHIV/AIDS in the last year(0.9 for each).Yet a substantial amount of variation in method choice was not accounted for by these variables. CONCLUSION: Future research should emphasize the collection of community-level data on structural,behavioral and cultural factorsto help explain the variation inmethod choice between communities.

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