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Objectives: Evidence on method dissatisfaction among current contraceptive users is sparse. Group-based trajectory modeling presents a novel approach to describing method dissatisfaction., Study Design: In a cohort of Kenyan women using modern contraception, we identified group-based trajectories of method dissatisfaction over 24 weeks since clinic visit., Results: Among 947 women, four trajectories were identified: consistent satisfaction (71%), increasing dissatisfaction (18%), decreasing dissatisfaction (8%), and consistent dissatisfaction (3%)., Discussion: Method dissatisfaction was common in a cohort of Kenyan women. Group-based trajectory models describe distinct and changing experiences of contraceptive use. Deeper understanding of trajectories of contraceptive experience may be useful for advancing person-centered family planning care that addresses users' changing preferences and challenges., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the contribution of specific contraceptive side effects to method switch and modern-method discontinuation among Kenyan women., Design: A prospective cohort study., Setting: Five counties in Western Kenya., Participants: Women aged ≥18 years old and emancipated female minors ≥14 years old using modern, reversible contraception were recruited while attending 10 public health facilities., Methods: Patient-reported adverse effect symptoms, method switch and discontinuation were reported through weekly text message-based surveys for 24 weeks., Main Outcome Measurements: Prevalence, hazards ratio (HR)., Results: Among 825 women, 44% were using implants, 43% injectables, 7% an intrauterine device and 6% oral contraceptive pills at enrolment. Most (61%) women were continuing a method used in the previous month. During the 24-week follow up, incidence of contraceptive switch was 61.3 per 100 person-years (95% confidence interval [CI] 52.4-71.8) and incidence of discontinuation was 38.5 per 100 person-years (95% CI 31.6-47.0). On average, one-quarter (prevalence [Pr] 0.24, 95% CI 0.22-0.26) of participants reported side effects or method problems weekly, with sexual side effects the most prevalent symptom (Pr 0.15, 95% CI 0.13-0.16). Lack of expected bleeding was associated with higher risk of method switch (adjusted hazard ratio [aHR] 2.36, 95% CI 1.22-4.57). Risk of all-modern method discontinuation was higher among women experiencing irregular bleeding (aHR 2.39, 95% CI 1.20-4.77), weight changes (aHR 2.72, 95% CI 1.47-4.68) and sexual side effects (aHR 2.42, 95% CI 1.40-4.20)., Conclusions: Addressing irregular bleeding, weight changes and sexual side effects through development of new products that minimise these specific side effects and anticipatory counseling may reduce method-related discontinuation., Tweetable Abstract: Bleeding, weight changes, sexual problems associated with discontinuation of #contraception, but many continue despite side effects., (© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Objective: To assess the effect of short message service (SMS) communication on facility delivery, exclusive breastfeeding (EBF), and contraceptive use., Design: Mobile WACh was a three-arm unblinded individually randomised controlled trial., Setting: A public sector maternal child health (MCH) clinic in Nairobi, Kenya., Population: Three hundred women attending antenatal care were randomised, 100 to each arm, and followed for 24 weeks postpartum. Pregnant women, at least 14 years old with access to a mobile phone and able to read SMS were eligible for participation., Methods: Women were randomised (1:1:1) to receive one-way SMS versus two-way SMS with a nurse versus control. Weekly SMS content was tailored for maternal characteristics and pregnancy or postpartum timing., Main Outcome Measures: Facility delivery, EBF, and contraceptive use were compared separately between each intervention arm and the control arm by Kaplan-Meier analysis and chi-square tests using intent-to-treat analyses., Results: The overall facility delivery rate was high (98%) and did not differ by arm. Compared with controls, probability of EBF was higher in the one-way SMS arm at 10 and 16 weeks, and in the two-way SMS arm at 10, 16, and 24 weeks (P < 0.005 for all). Contraceptive use was significantly higher in both intervention arms by 16 weeks (one-way SMS: 72% and two-way SMS: 73%; P = 0.03 and P = 0.02 versus 57% control, respectively); however, this difference was not significant when correcting for multiple comparisons., Conclusion: One-way and two-way SMS improved EBF practices and early contraceptive use. Two-way SMS had an added benefit on sustained EBF, providing evidence that SMS messaging influences uptake of interventions that improve maternal and neonatal health., Source of Funding: Funding was provided by the National Institutes of Health (K12HD001264 to JAU, R01HD080460, K24HD054314 to GJS, and K01AI116298 to ALD), the National Science Foundation (Graduate Research Fellowship to TP and BD), as well as the University of Washington Global Center for Integrated Health of Women Adolescents and Children (Global WACh)., Tweetable Abstract: The Mobile WACh RCT demonstrates that SMS improved practice of exclusive breastfeeding and early postpartum contraception., (© 2018 Royal College of Obstetricians and Gynaecologists.)

Objective: The objective was to characterize uptake and correlates of effective contraceptive use postpartum., Study Design: We analyzed data from a national, cross-sectional evaluation of prevention of mother-to-child HIV transmission programs that enrolled women attending 6-week or 9-month infant immunization visits at 120 Kenyan maternal and child health clinics. We classified women who resumed sexual activity postpartum and did not desire a child within 2 years as having a need for family planning (FP)., Results: We included 955 (94%) of 1012 women 8-10 months postpartum in the analysis. Mean age was 25.8 years and 36% were primigravidas. By 9 months postpartum, 62% of all women used contraception and 59% used effective contraception [injectables, implants, intrauterine devices [IUDs], oral contraceptives [OCs] and tubal ligations]. Most contraceptive users (61%) used injectables, followed by implants (10%), OCs (6%), IUDs (4%) and condoms alone (2%). The majority (n=733, 77%) had a need for FP, and 67% of 733 women with FP need used effective contraception. Among women with a need for FP, effective contraception use was higher among those who discussed FP in postnatal care (PNC) than who did not discuss FP in PNC [prevalence ratio (PR) for PNC alone: 1.35, 95% confidence interval (CI): 1.16-1.58; PR for PNC and antenatal care (ANC): 1.42, 95% CI: 1.21-1.67; p=.001 for both]., Conclusions: Two thirds of postpartum women with a need for FP used effective contraception at 9 months postpartum, and use was associated with discussing FP during PNC., Implications: Integrating FP counseling in ANC/PNC could be an effective strategy to increase effective contraception use., (Published by Elsevier Inc.)

Objective: To determine the contribution of specific contraceptive side effects to method switch and modern‐method discontinuation among Kenyan women. Design: A prospective cohort study. Setting: Five counties in Western Kenya. Participants: Women aged ≥18 years old and emancipated female minors ≥14 years old using modern, reversible contraception were recruited while attending 10 public health facilities. Methods: Patient‐reported adverse effect symptoms, method switch and discontinuation were reported through weekly text message‐based surveys for 24 weeks. Main outcome measurements: Prevalence, hazards ratio (HR). Results: Among 825 women, 44% were using implants, 43% injectables, 7% an intrauterine device and 6% oral contraceptive pills at enrolment. Most (61%) women were continuing a method used in the previous month. During the 24‐week follow up, incidence of contraceptive switch was 61.3 per 100 person‐years (95% confidence interval [CI] 52.4–71.8) and incidence of discontinuation was 38.5 per 100 person‐years (95% CI 31.6–47.0). On average, one‐quarter (prevalence [Pr] 0.24, 95% CI 0.22–0.26) of participants reported side effects or method problems weekly, with sexual side effects the most prevalent symptom (Pr 0.15, 95% CI 0.13–0.16). Lack of expected bleeding was associated with higher risk of method switch (adjusted hazard ratio [aHR] 2.36, 95% CI 1.22–4.57). Risk of all‐modern method discontinuation was higher among women experiencing irregular bleeding (aHR 2.39, 95% CI 1.20–4.77), weight changes (aHR 2.72, 95% CI 1.47–4.68) and sexual side effects (aHR 2.42, 95% CI 1.40–4.20). Conclusions: Addressing irregular bleeding, weight changes and sexual side effects through development of new products that minimise these specific side effects and anticipatory counseling may reduce method‐related discontinuation. Bleeding, weight changes, sexual problems associated with discontinuation of #contraception, but many continue despite side effects. Bleeding, weight changes, sexual problems associated with discontinuation of #contraception, but many continue despite side effects. [ABSTRACT FROM AUTHOR]