Understanding the association between informed choice and long-term reversible contraception among women aged 15-49 in Uganda: findings from the 2016 Demographic Health Survey

Abstract IntroductionLong-acting reversible contraceptive (LARC) methods are superior to other modern birth control methods in preventing pregnancy as they are highly effective and have a low failure rate. The Ugandan Ministry of Health has prioritized providing long-acting reversible contraception (LARC) and ensuring informed choice within the context of family planning. This study aims to understand the relationship between informed choice and LARC use among women aged 15-49 in Uganda after adjusting for potential confounding.MethodsThis cross-sectional study utilizes data from the 2016 Uganda Standard Demographic and Health Survey. Thomas-Rao corrections to a chi-square test were used for the bivariable analysis. A design-adjusted multivariable logistic regression was used to estimate the association between informed choice and LARC use. Propensity score matching was conducted as a sensitivity analysis.ResultsIn all, 3,646 women were included in the analysis and 975 reported using a LARC. In the design- adjusted multivariable analysis, the odds of reporting LARC usage were 1.98 (95% CI 1.61 - 2.43) times higher among women who reported informed choice compared to those who did not. The subsequent propensity score analysis reported similar findings.DiscussionProviding informed choices can help increase the number of women who utilize LARCs in Uganda. As such, the Ugandan Ministry of Health should further expand access to family planning counselling as it could contribute to the reduction of unplanned pregnancies across Uganda through the use of LARCs.Significance: There is currently no research on the association between informed choice and long-term reversible contraception (LARC) use in Uganda. More broadly, research in relation to informed choice and LARC use in sub-Saharan Africa is largely descriptive. This association is important to understand because Uganda has one of the highest unplanned pregnancy and fertility rates in the world. The study will contribute to a better understanding of family planning counselling in Uganda, which may be useful in developing future family planning programs and interventions. As such, this will help reduce the overall unplanned pregnancy rate in Uganda.