The Trends of Using Different Contraceptive Agents and its Drawbacks: A Multicenter Observational Study

The purpose of this study was to track changing patterns of contraceptive use, particularly long-term strategies and their disadvantages. Bangladesh is a country with a high density of population, with 1260 people living per square kilometer. Due to the availability of free contraceptive techniques provided by the Bangladeshi Ministry of Health and several non-governmental organizations (NGOs), our total fertility rate (TFR) has been decreased to 2.3. However, the use of family planning is still subpar, especially for long-term and irreversible techniques; as a result, the number of unexpected as well as unplanned pregnancies is rising quickly. Due to the over-the-counter (OTC) availability of abortifacient medications in our nation, such as misoprostol and mifepristone, people are ingesting them unsupervisedly at the incorrect dosage and gestational age. Despite the fact that most of these women are aware of the various forms of conventional contraceptive techniques, unsafe abortions are therefore on the rise. The study design was accepted by the Ethical Review Committee of the Combined Military Hospital (CMH) of Bogura. In total, 32629 women were enrolled in the present study. This retrograde observational study was conducted from July 2017 to June 2019 in four hospitals/clinics- Combined Military Hospital (CMH) of Bogura, Thengamara Mahila Shobuj Shangha (TMSS) Medical College and Hospital, Mary Stopes Clinic (MSC), and Shurjer Hashi Clinic (SHC). These centers were selected purposively as they have distinct family planning sections as well and they maintain well-structured data. Different parameters were compared between 2017 and 2018. Statistical analysis was done using SPSS (version 10), and the result, which is less than or equal to 0.05 has been signified as “statistically significant”. Among the different contraception like short-acting methods (oral contraceptive pill (OCP), condom, and injectable hormones) and long-acting methods (intrauterine contraception device (IUCD), and implant) and permanent methods (tubectomy and vasectomy), the study observed that in Bogura CMH the number of OCP and condom users significantly increased in 2018 compared to that of 2017 and the p-value is 0.047 and 0.039, respectively. In 2018 IUCD users were reduced considerably (p=0.0001) in CMH Bogura compared to the previous year whereas in other hospitals/clinics, the outcome was non-significant. In the case of implant users, the number is almost similar in all the centers (for TMSS p=0.063; SHC p=0.25; MSC p=0.71), but surprisingly in CMH Bogura, no users were found in both years. For the injectable users, although it was significantly increased in MSC (p= 0.005), but significantly reduced in TMSS (p=0.043) whereas slightly reduced in CMH Bogura (p= 0.13) & SHC (p=0.226). The use of OCP was increased dramatically in MSC (0.01) and CMH Bogura (p=0.047); whereas significantly reduced in SHC (p=0.008). In TMSS and CMH Bogura the condom users were increased considerably (p=0.035 and p=0.039, respectively). In the case of tubal ligation, no change was observed in any center, whereas in the case of male sterilization, it was observed that it was absent in three centers but in MSC, it increased suddenly in the second year. The number of induced abortions after using misoprostol mifepristone was increased. They are admitted to the hospital with excess haemorrhage and infection. Preference for these agents is due to quick action and short dose. It is important to focus the long-acting contraceptive campaign. Family planning officers should be well-trained. Abortion-inducing medications should only be available by prescription from a doctor or other healthcare professional, with restrictions on their availability over the counter.