The role of dissatisfaction on contraceptive uptake among ever users and never users in Uganda; evidence from a longitudinal study

Linnea Zimmerman, Johns Hopkins Bloomberg School of Public Health
Sophia Magalona, Johns Hopkins Bloomberg School of Public Health
Celia Karp, Johns Hopkins Bloomberg School of Public Health
Saifuddin Ahmed, Johns Hopkins University

Satisfaction with use of contraceptive methods affects continuation and may contribute to community acceptance or hesitancy around contraceptive use. We use longitudinal data from PMA Plus in Uganda to assess the effect of community-level dissatisfaction on contraceptive uptake among non-users at baseline. We assess the effect of dissatisfaction separately among never versus ever users. Our primary outcome is use of a modern contraceptive method at follow-up and our measures of interest are community-level dissatisfaction and, among ever users, previous contraceptive discontinuation due to dissatisfaction. We include interaction terms of intention to use a method at baseline. Among never users, intention to use, but not community dissatisfaction, is significantly associated with use. Among ever users, intention moderates the relationship of dissatisfaction; women with no intention to use contraception who live in communities with high dissatisfaction have significantly lower odds of using contraception at follow-up. Despite high levels of dissatisfaction among ever users, previous discontinuation because of dissatisfaction did not have a significant effect. Our findings underscore that non-users are a heterogeneous group and that the effect of satisfaction/dissatisfaction differs between ever and never users. Next steps include using structural equation modeling to assess whether intention mediates, rather than moderates, this relationship.

Keywords: Family planning and contraception, Longitudinal studies, Structural equation modelling

See extended abstract.

  Presented in Session 65. Factors Inhibiting Continuity in Contraceptive Use