Pill Compliance: Do the Users Really Understand about Its Use-Effectiveness?

Mehrab A. Khan, ICDDR,B: Centre for Health and Population Research
AHM Golam Mustafa, ICDDR,B: Centre for Health and Population Research
Manoj K. Barua, ICDDR,B: Centre for Health and Population Research
Radheshyam Bairagi, ICDDR,B: Centre for Health and Population Research

Context: Pill is the most popular family-planning (FP) method among married women of reproductive age (MWRA) in Bangladesh. According to recent Bangladesh Demographic and Health Survey report, 23 percent of women were using pill which accounts for 43 percent of all contraceptive use and 53 percent of modern method use in the country. Despite the popularity of pill, its users often do not follow correct use procedures. The pill is a highly effective contraceptive method but its use failure (becoming pregnant) in this country is very high. Objectives: The present study examines whether the users know the proper timing of its use, and its compliances and effectiveness. Methods: Data for this study came from two rural thanas in Bangladesh: one is Matlab, a well known research site of ICDDR,B: Centre for Health and Population Research where extensive coverage of maternal child health and family planning services are being provided since late 1977 and Kalkini, where the services are being offered through regular government programme. A sample of 200 MWRA was selected on sample basis in each area from women who were using pill two-months before the survey. The structured questionnaire was administered to conduct the quantitative survey. Some qualitative data were also collected from a sample users and service providers to supplement the quantitative findings collected through the survey. Results: Results show that 34 percent of the pill user in Kalkini used it since their husband or in-laws advised to take pill while in Matlab the similar proportion of users used pill as it is suited to them. In response to a question about to start to use pill after menstrual cycle, it is observed that different menstrual cycle follows among women in both the areas. About 8 percent of the pill users in both the areas reported that they became pregnant while using pill. Almost all of the users in both the areas reported that they didn't take the pill properly which is the main reason for becoming pregnant. Like other studies, proportion of side-effects are common as is observed in both the areas. It is documented whether pill user used pill according to the arrow marked in the leaf of pill. In Matlab, about 8 percent of the users didn't follow it since majority of the users didn't know about it while in Kalkini this proportion was more than double. It indicates that some women in both the areas were not taking the pill properly. Taking pills out of sequence can result in taking placebo pills at the wrong time in the pill cycle which may increase the risk of pregnancy. The qualitative information suggests that pill users often forgot to take pill in a timely manner, especially when they visit elsewhere for social reasons. The qualitative information collected from service providers indicates that in spite of repeated advice to take pill properly, the users are making the same mistakes. Conclusion: The findings suggest that some proportion of users are using pill without knowing much about its use and use-effectiveness. Since pill is the most popular FP method among MWRA due to its ease of use, special attention to make it more effective is urgently required. More training for grass-root level field workers is expected to be helpful. Programme managers and policy makers also need to review different methods, and side-effects of each method. The health and family-planning programme strategies should also include men's involvement in family-planning to increase the use of method with minimum side-effects.