“Side effects affected my daily activities a lot”: a qualitative exploration of the impact of contraceptive side effects in Bangladesh

Abstract

Purpose: In a country like Bangladesh that has made great progress in contraceptive use with one of the lowest levels of fertility and highest levels of contraceptive use, understanding what factors influence women's decisions to discontinue a contraceptive method and not switch to a new method is critical in designing interventions and programs that will help enable Bangladesh to reach its FP2020 goals. Research on side effects has focused on physical manifestations like headaches, moodiness, abdominal pain, and menstrual irregularities. While physical effects alone may stop women from continuing a contraceptive method, less is known about how side effects influence women's daily activities and lives. The purpose of this study is to understand the ways that side effects affect Bangladeshi women's participation in different social settings. Methods: Thirty-five in-depth interviews with married women who recently discontinued or switched to a different contraceptive method were conducted in Sylhet and Khulna Divisions. Interviews explored reasons for discontinuation including experience of side effects and impact of side effects on women's lives. Results: Key themes emerged including that side effects are not only experienced physically but are barriers to women's participation in many aspects of their lives. The spheres of life that most commonly appeared to be influenced by side effects include religion, household, and sexual intimacy irrespective of method used or residence. Conclusion: Family planning providers need to be aware of these additional consequences associated with contraceptive side effects to provide tailored counseling that recognizes these issues and helps women to mitigate them. For Bangladesh to achieve its FP2020 goals, understanding the broader context in which family planning decisions are made vis-à-vis side effects is critical to design programs and interventions that meet all the needs of women beyond just their fertility intentions. Keywords: family planning discontinuation and switching, qualitative research, experience of side effects Introduction Unintended pregnancies are a major consequence of contraceptive discontinuation. In 2012, there were ~213 million pregnancies, roughly 40% (85 million) of which were unintended. 1 Unintended pregnancies have been linked to many negative health behaviors and outcomes for the mother and child including abortion-related morbidity and mortality, maternal mortality, breastfeeding behaviors, timing of antenatal visits, low birth weight, poor child nutrition and incomplete vaccinations, infant mortality, and depression and anxiety. 2,3 Recently, it has been shown that across 36 Demographic and Health Survey (DHS) countries, one-third of unintended pregnancies are the result of contraceptive