[Year:2021] [Month:May-June] [Volume:13] [Number:3] [Pages:5] [Pages No:180 - 184]
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.