Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 13 , ISSUE 3 ( May-June, 2021 ) > List of Articles


A Multicenter Observational Study to See the Trends of Using Different Contraceptive Agents and Its Drawbacks

Umme Ruman, Mir M Rhaman, Monowara Khatun

Keywords : Contraception, Incomplete abortion, Long-acting reversible contraception (LARC), Misoprostol

Citation Information : Ruman U, Rhaman MM, Khatun M. A Multicenter Observational Study to See the Trends of Using Different Contraceptive Agents and Its Drawbacks. J South Asian Feder Obs Gynae 2021; 13 (3):180-184.

DOI: 10.5005/jp-journals-10006-1908

License: CC BY-NC 4.0

Published Online: 09-09-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Aim: Bangladesh is a densely populated country where approximately 1,260 people are living per square kilometer. The Ministry of Health of Bangladesh and different Non-Governmental Organizations are providing free contraceptive methods, and for its availability now, our total fertility rate (TFR) is reduced to 2.3. However, due to ignorance and reluctance, family planning utilization is yet suboptimal, especially that of long-term and irreversible methods; and thus, an unexpected, as well as unplanned pregnancy is increasing at a pace. Due to the availability of over-the-counter (OTC) abortifacient drugs like misoprostol and mifepristone (MM) kit in our country, people are consuming unsupervised not only the wrong dose but also in a wrong gestational age. Thus, unsafe abortion is highly increasing, although most of these women know about different types of regular contraceptive methods. In this study, our aim was to observe the trends of using contraception, especially the long-term methods and its drawback. Methods and materials: The study design was accepted by the Ethical Review Committee of Combined Military Hospital (CMH) of Bogura. In total, 32,629 women were enrolled in the present study. This retrograde observational study was conducted from July 2017 to June 2019 in four hospitals/clinics—CMH of Bogura, Thengamara Mahila Shobuj Shangha (TMSS) Medical College and Hospital, Mary Stopes Clinic (MSC), and Shurjer Hashi Clinic (SHC). These centers were selected purposively as they have distinct family planning section as well as they maintain well-structured data. Different parameters were compared between 2017 and 2018. Statistical analysis was done using SPSS (version 10), and the result that is lower than or equal to 0.05 has been signified as “statistically significant.” Results: Among the different contraceptions like short-acting methods [oral contraceptive pill (OCP), condom, and injectable hormones] and long-acting methods [intrauterine contraception device (IUCD) and implant] and permanent methods (tubectomy and vasectomy), the study observed that in CMH of Bogura, the number of OCP and condom users have significantly increased in 2018 compared to that of 2017, and the p-value is 0.047 and 0.039, respectively. In 2018, IUCD users are significantly reduced (p = 0.0001) in CMH of Bogura, compared to the previous year, whereas in other hospitals/clinics, the outcome is nonsignificant. In the case of implant users, the number is almost similar in all the centers (for TMSS, p = 0.063; SHC, p = 0.25; MSC, p = 0.71), but surprisingly in CMH of Bogura, no users were found in both years. For the injectable users, it significantly increased in MSC (p = 0.005) but significantly decreased in TMSS (p = 0.043), whereas it slightly decreased in CMH of Bogura (p = 0.13) and SHC (p = 0.226). The use of OCP was significantly increased in MSC (0.01) and CMH of Bogura (p = 0.047), whereas it was significantly reduced in SHC (p = 0.008). In TMSS and CMH of Bogura, the condom users were significantly increased (p = 0.035 and p = 0.039, respectively). In the case of tubal ligation, no change was observed in any center, whereas in the case of male sterilization, it was observed that it was absent in the three centers, but in MSC, it has increased suddenly in the second year. The number of induced abortions after using MM kit was increased. They are admitted to hospital with excess hemorrhage and infection. Preference of these agents is due to quick action and short dosage. Conclusion: Campaign for long-acting contraception should be emphasized. Well-trained family planning officer should be employed. OTC availability of abortifacient drugs should be restricted, and it should only be prescribed by the doctor or health provider.

PDF Share
  1. Greenspan A. Fertility decline in Bangladesh: an emerging family planning success story. Asia Pac Popul Policy 1992;20:1–4. PMID: 12285494
  2. Huda FA, Robertson Y, Chowdhuri S, et al. Contraceptive practices among married women of reproductive age in Bangladesh: a review of the evidence. Reprod Health 2017;14(1)69. DOI: 10.1186/s12978-017-0333-2.
  3. Bairagi R, Islam M, Barua MK. Contraceptive failure: levels, trends and determinants in Matlab, Bangladesh. J Biol Sci 2000;32(1):107–123. DOI: 10.1017/s0021932000001073.
  4. Blumenthal P, Voedisch A, Gemzell-Danielsson K. Strategies to prevent unintended pregnancy: increasing use of long-acting reversible contraception. Hum Reprod 2011;17(1):121–137. DOI: 10.1093/humupd/dmq026.
  5. Trussell J, Guthrie K. Choosing a contraceptive: efficacy, safety, and personal considerations. In: Hatcher RA, Trussell J, Nelson AL, et al., editors. Contraceptive technology. 19th ed. New York, NY, USA: Ardent Media, Inc.; 2007. p. 19–47.
  6. Jacobstein R, Stanley H. Contraceptive implants: providing better choice to meet growing family planning demand. Glob Health Sci Pract 2013;1(1):11–17. DOI: 10.9745/GHSP-D-12-00003.
  7. Bangladesh Demographic and Health Survey 2014. National Institute of Population Research and Training (NIPORT). Dhaka: Ministry of Health and Family Welfare; 2015.
  8. Adolescent Health Fact Sheet. WHO. 2007.
  9. Hossain A, Maddow-Zimet I, Ingerick M, et al. Access to and quality of menstrual regulation services and postabortion care in Bangladesh, 2014, New York: Guttmacher Institute; 2017.
  10. The medical termination of pregnancy amendment act, 2002. No. 62 of 2002, 18th December 2002.
  11. Comprehensive abortion care training and service delivery guideline. Ministry of Health and Family Welfare Government of India; 2010.
  12. Mundle S, Elul B, Anand A, et al. Increasing access to safe abortion services in rural India: experiences with medical abortion in a primary health centre. Contraception 2007;6:66–70. DOI: 10.1016/j.contraception.2007.03.010.
  13. Coyaji K, Elul B, Krishna U, et al. Mifepristone-misoprostol abortion: a trial in rural and urban Maharashtra, India. Contraception 2002;66:33–40. DOI: 10.1016/S0010-7824(02)00309-8.
  14. Kopp Kallner H, Fiala C, Stephansson O, et al. Home self-administration of vaginal misoprostol for medical abortion at 50–63 days compared with gestation of below 50 days. Hum Reprod 2010;25:1153–1157. DOI: 10.1093/humrep/deq037.
  15. Kahn JG, Becker BJ, MacIssac L, et al. The efficacy of medical abortion: a meta-analysis statistics.
  16. Lara D, Garcia SG, Wilson KS, et al. How often and under which circumstances do Mexican Pharmacy vendors recommend misoprostol to induce an abortion? Int Perspect Sex Reprod Health 2011;37:75–83. DOI: 10.1363/3707511.
  17. Bangladesh Demographic and Health Survey 2007. National Institute of Population Research and Training (NIPORT), Dhaka, Bangladesh; 2009.
  18. Ontiri S, Ndirangu G, Kabue M, et al. Long-acting reversible contraception uptake and associated factors among women of reproductive age in rural Kenya. Int J Environ Res Public Health 2019;16(9):1543. DOI: 10.3390/ijerph16091543.
  19. Singh S, Hossain A, Zimet IM, et al. The incidence of menstrual regulation procedures and abortion in Bangladesh, 2014. Int Perspect Sex Reprod Health 2017;43(1):1–11. DOI: 10.1363/43e2417.
  20. Health, Population, and Nutrition Sector Development Program (2011–2016), Program Implementation Plan. In: MoH & FW, editor. Dhaka: Government of Bangladesh.
  21. Kenya National Bureau of Statistics. Ministry of Health/Kenya. National AIDS Control Council/Kenya. Kenya Medical Research Institute. National Council for Population Development/Kenya. Kenya demographic and health survey 2014. Rockville, MD, USA: ICF Macro; 2015.
  22. Shenon C, Perry Brothers L, Philip NM, et al. Infection after medical abortion: a review of literature. Contraception 2004;70(3):183–190. DOI: 10.1016/j.contraception.2004.04.009.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.