Craig J Heck1, Stephanie A Grilo2, Xiaoyu Song3, Tom Lutalo4, Neema Nakyanjo5, John S Santelli6. 1. Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Avenue, Suite, B-2, New York, NY, USA. Electronic address: craig.heck1@gmail.com. 2. Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Avenue, Suite, B-2, New York, NY, USA. Electronic address: sag2179@cumc.columbia.edu. 3. Department of Population Health Science and Policy & Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai. Electronic address: xiaoyu.song@mountsinai.org. 4. Rakai Health Sciences Program, Kalisizo, Uganda. Electronic address: tlutalo@rhsp.org. 5. Rakai Health Sciences Program, Kalisizo, Uganda. Electronic address: neema@rhsp.org. 6. Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Avenue, Suite, B-2, New York, NY, USA. Electronic address: js2637@columbia.edu.
Abstract
OBJECTIVES: Covert contraceptive use (CCU) is the use of family planning without a partner's knowledge. This study sought to examine CCU prevalence among women living in Rakai, Uganda, predictors of CCU, and why women resort to CCU. STUDY DESIGN: We used data from women (15-49years) currently using contraceptives (oral contraceptives, Depo Provera, implants, intrauterine devices, and periodic abstinence) during Round 15 (2011-2013) of the Rakai Community Cohort Survey (n=2206). We utilized logistic regressions to analyze the association between self-reported CCU and current contraceptive method, sexual activity, experience of violence, and demographic data. We also used data from in-depth interviews (IDI) on HIV and reproductive health conducted in 2013-2016. RESULTS: CCU prevalence was 26%. In the multivariable model, being previously married (aOR=2.2 [1.7-2.9]), having no formal education (aOR=2.1 [1.1-3.9]), and experiencing physical violence (aOR=1.7 [1.3-2.2]) or having more than 1 sex partner (aOR=1.6 [1.2-2.2]) in the past 12months were CCU predictors. Advancing past primary school decreased the odds of CCU (aOR=0.7 [0.6-0.9]). HIV was positively associated with CCU in the unadjusted model, but not the adjusted. In the IDIs, women primarily resorted to CCU because of discordant fertility desires-coupled with financial insecurity, negative stereotypes towards contraceptives use, deteriorating health, and familial pressure to reproduce. One woman employed CCU because she feared being ostracized from her community. CONCLUSIONS: CCU is common amongst users of contraception and is used to hide family planning from partners and communities. Women that diverge from Uganda's cultural norms had higher odds of CCU. IMPLICATIONS: Clinicians and practitioners should be aware of CCU among their patients and should educate women on the wide variety of contraceptive methods to help them decide if their current covert method is best for their health and safety.
OBJECTIVES: Covert contraceptive use (CCU) is the use of family planning without a partner's knowledge. This study sought to examine CCU prevalence among women living in Rakai, Uganda, predictors of CCU, and why women resort to CCU. STUDY DESIGN: We used data from women (15-49years) currently using contraceptives (oral contraceptives, Depo Provera, implants, intrauterine devices, and periodic abstinence) during Round 15 (2011-2013) of the Rakai Community Cohort Survey (n=2206). We utilized logistic regressions to analyze the association between self-reported CCU and current contraceptive method, sexual activity, experience of violence, and demographic data. We also used data from in-depth interviews (IDI) on HIV and reproductive health conducted in 2013-2016. RESULTS:CCU prevalence was 26%. In the multivariable model, being previously married (aOR=2.2 [1.7-2.9]), having no formal education (aOR=2.1 [1.1-3.9]), and experiencing physical violence (aOR=1.7 [1.3-2.2]) or having more than 1 sex partner (aOR=1.6 [1.2-2.2]) in the past 12months were CCU predictors. Advancing past primary school decreased the odds of CCU (aOR=0.7 [0.6-0.9]). HIV was positively associated with CCU in the unadjusted model, but not the adjusted. In the IDIs, women primarily resorted to CCU because of discordant fertility desires-coupled with financial insecurity, negative stereotypes towards contraceptives use, deteriorating health, and familial pressure to reproduce. One woman employed CCU because she feared being ostracized from her community. CONCLUSIONS:CCU is common amongst users of contraception and is used to hide family planning from partners and communities. Women that diverge from Uganda's cultural norms had higher odds of CCU. IMPLICATIONS: Clinicians and practitioners should be aware of CCU among their patients and should educate women on the wide variety of contraceptive methods to help them decide if their current covert method is best for their health and safety.
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