Prevalence and correlates of long-acting reversible contraceptive use among multipara women with disabilities in Iganga District – Eastern Uganda

Abstract

Background: Numbering at more than 50 million, women with disabilities are an indispensable population in the efforts to reduce maternal mortality, given that they possess two of the characteristics that increase the risk for obstetric complication incidence and mortality. One of them is being disabled, which alone increases risk for urinary tract infections, chorioamnionitis, preterm rapture of membranes, and ischemic uterine diseases with their resultant complications notably postpartum hemorrhage. The incidence and prognosis of those complications depends in the large part on parity, being exacerbated with multiparity, given its inverse relationship with birth intervals. As such, for multipara women with disabilities that still have fertility desires, the use of long acting reversible contraception remains the most viable option for ensuring optimal birth intervals and obstetric complication risk reduction. Objective: The purpose of this study was to determine the prevalence and correlates of Long Acting Reversible Contraceptive use among multipara women with disabilities in Iganga district – Eastern Uganda Methods: Across sectional survey was used, targeting 148 multipara women with disabilities in Iganga district. The women were sampled at IDIWA and spinal injury association of Iganga offices, consecutively, and engaged in structured interviews. Data were analyzed in STATA using descriptive statistics, and the Poisson distribution Results: Almost a quarter of the women with disabilities were currently using a form of LARCs 22.3% (n = 33). At an individual level, LARC use prevalence was less by 71% among women who were of parity 2 (aPR = 0.288 [0.110 - 0.755], p = 0.011). From a spousal perspective, LARC use prevalence was higher by two and half times among women whose spouses were in monogamous relationships (aPR = 2.572 [1.287 - 5.139], p = 0.007), but less by 79% among women whose spouses had received formal education (aPR = 0.210 [0.093 - 0.472], p <0.001). It was twice as high among women whose husbands had ever initiated a conversation about FP (aPR = 2.612 [1.468 - 4.648], p = 0.001). The prevalence of LARC use was 8 times higher among women who had ever been told about LARCs by any health workers in district (aPR = 8.064 [2.018 - 32.219], p = 0.030). The prevalence of LARC use was five times as high among disabled women who perceived that multipara women with disabilities were given priority at health facilities (aPR = 5.627 [2.104 - 15.049], p = 0.001). Conclusion: Long acting reversible contraceptive use among multipara women with disabilities in Iganga district is low, with utilization of only 2 in 10. Individual, spousal and health service factors have a significant correlation with the use of LARCs in that population, spousal characteristics being the most important, followed by health service characteristics.