Noncompliance among oral contraceptive acceptors in rural Bangladesh

Abstract

The levels of noncompliance among 175 oral contraceptive acceptors in a rural area of Bangladesh were monitored for three to four months. Unexpectedly high levels of noncompliance were observed, including both overconsumption and underconsumption of oral contraceptive pills. Although the study was designed to investigate only the levels of noncompliance and not the causes and consequences of noncompliance, some useful indications of the factors associated with noncompliance were obtained. The results indicate that noncompliance is a significant factor in family planning programs and, as such, warrants further in-depth investigation.

PIP: The levels of noncompliance among 175 oral contraceptive acceptors in a rural area of Bangladesh were monitored for 3-4 months. Unexpectedly high levels of noncompliance were observed, including both overconsumption and underconsumption of oral contraceptive pills. Although the study was designed to investigate only the levels of noncompliance and not the causes and consequences of noncompliance, some useful indications of the factors associated with noncompliance were obtained. The results indicate that noncompliance is a significant factor in family planning programs and, as such, warrants further indepth investigation. The study was undertaken within the Maternal and Child Health and Family Planning (MCH-FP) program of the International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B) in Matlab Thana, Comilla District, Bangladesh. All oral contraceptive acceptors in 2 of the 4 areas of the MCH-FP program were studied for 3-4 months, within the period May-September 1982. During routine biweekly visits to clients under the program, the community health workers recorded their observations and any pertinent comments volunteered by clients. Recorded observations include the date of the visit, number of unopened OC cycles in the client's possession and the number of pills removed from the OC cycle in current use. Among OC acceptors in the developed countries, occasionally forgetting to take the OC pill seems to be a common occurrence but since the packets are generally marked with a calendar, the omissions are usually quickly discovered and corrected. Illiterate women, however, cannot benefit from such remainders. Noncompliance occurs in the ICDDR,B MCH-FP program to a substantially greater extent than was ever considered likely. The number of clients having moderate levels of noncompliance was low even when compared to the number of users who were compliant. OC acceptors generally fall into 2 categories: those who follow the prescribed regimen carefully and are compliant and those who have their own perceptions of how OC pills should be taken, which may only loosely relate to the prescribed regimen and are therefore highly noncompliant