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What Is the Impact of Contraceptive Methods and Mixes of Contraceptive

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Systematic review What is the impact of contraceptive methods and mixes of contraceptive methods on contraceptive prevalence, unmet need for family planning, and unwanted and unintended pregnancies? by Heather MacKenzie, Amy Drahota, Sasseendran Pallikadavath, Willian Stones Taraneh Dean, Carole Fogg, Rebecca Stores, Sally Kilburn, Ann Dewey and Reuben Ogollah November 2013 This material has been funded by the Department for International Development. The views expressed do not necessarily reflect the views of the Department for International Development. The authors are part of the University of Portsmouth, UK, and Aga Khan University, Kenya; and were supported by the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre). The EPPI-Centre reference number for this report is 2108. MacKenzie H, Drahota A, Pallikadavath S, Stones W, Dean T, Fogg C, Stores R, Kilburn S, Dewey A, Ogollah R (2013) What is the impact of contraceptive methods and mixes of contraceptive methods on contraceptive prevalence, unmet need for family planning, and unwanted and unintended pregnancies? An overview of systematic reviews. EPPI-Centre, Social Science Research Unit, Institute of Education, University of London. ISBN: 978-1-907345-61-6 © Copyright Authors of the systematic reviews on the EPPI-Centre website (http://eppi.ioe.ac.uk/) hold the copyright for the text of their reviews. The EPPI- Centre owns the copyright for all material on the website it has developed, including the contents of the databases, manuals, and keywording and data extraction systems. The centre and authors give permission for users of the site to display and print the contents of the site for their own non-commercial use, providing that the materials are not modified, copyright and other proprietary notices contained in the materials are retained, and the source of the material is cited clearly following the citation details provided. Otherwise users are not permitted to duplicate, reproduce, re-publish, distribute, or store material from this website without express written permission. i Contents List of abbreviations ............................................................................. ii Abstract ........................................................................................... 1 Executive summary .............................................................................. 3 1. Background .................................................................................... 9 1.1 Aims and rationale for review...................................................... 9 1.2 Definition and conceptual issues .................................................. 9 1.3 Policy and practice background .................................................. 10 1.4 Research background ............................................................... 10 1.5 Conceptual framework ............................................................. 12 1.6 Focus of this review ................................................................ 14 1.7 Objectives ........................................................................... 14 2. Methods used in the review ............................................................... 15 2.1 User involvement ................................................................... 15 2.2 Identifying and describing reviews ............................................... 15 2.3 Methods for synthesis .............................................................. 17 2.4 Deriving conclusions and implications ........................................... 19 3. Search results ................................................................................ 20 3.1 Studies included from searching and screening ................................ 20 3.2 Details of the included reviews ................................................... 20 4. Synthesis results ............................................................................. 21 4.1 Further details of the reviews included in the synthesis ...................... 21 4.2 Quality of included reviews ....................................................... 21 4.3 Synthesis: quality assurance results .............................................. 22 4.4 Syntheses of evidence .............................................................. 22 5. Conclusions and recommendations ....................................................... 38 5.1 Sterilisation in developing countries ............................................. 38 5.2 Oral contraception in developing countries ..................................... 39 5.3 Intrauterine devices in developing countries ................................... 40 5.4 Injectables in developing countries .............................................. 41 5.5 Implants in developing countries ................................................. 41 5.6 Emergency contraception ......................................................... 42 5.7 Spermicides in developing countries ............................................. 42 5.8 Pre- and post-coital hormonal contraception in developing countries ...... 42 5.9 Natural family planning in developing countries ............................... 42 5.10 Gaps in the evidence ............................................................... 42 6. References .................................................................................... 44 6.1 Reviews included in overview ..................................................... 44 6.2 Other references used in the text of the technical report ................... 45 Appendices ....................................................................................... 48 Appendix 1.1: Authorship of this report .................................................. 48 Appendix 2.1: Inclusion and exclusion criteria .......................................... 50 Appendix 2.2: Search strategy for electronic databases ............................... 54 Appendix 2.3: Study eligibility form and notes .......................................... 66 Appendix 2.4: Data collection tool ........................................................ 72 Appendix 3.1: Table of included reviews ................................................. 82 Appendix 4.1: Tables of further information............................................ 100 Appendix 4.2: Overview of reviews tables .............................................. 128 Appendix 4.3: Contextual information for included studies from included reviews151 i List of abbreviations CBA Controlled before and after study CCT Controlled clinical trial COC Combined oral contraception CPR Contraceptive prevalence rate DHS Demographic and health surveys EC Emergency contraception FPE Family planning programme effort Index ICPD International conference on population and development ITS Interrupted time series IUD Intrauterine device LAM Lactational amenorrhea method MCH Maternal and child health MDG Millennium development goal OC Oral contraception OoR Overview of systematic reviews RCT Randomised controlled trial RR Risk ratio ii iii Abstract Background In many low-and middle-income countries, there is high maternal, infant and child mortality due in part to low contraceptive use and high unmet need for family planning. The aim of this overview of systematic reviews is to synthesise the findings of systematic reviews conducted in this area to assess the impact of various contraceptive methods and mixes of contraceptive methods on contraceptive prevalence, unwanted and unintended pregnancies, and unmet need (a desire to limit the number of children but not currently using any contraception) for family planning in developing countries/regions. Methods Eight databases (Bioline international, The Cochrane Library, Latin American and Caribbean Health Sciences Literature - LILACS, Popline, PubMed, Turning Research Into Practice, World Health Organisation Reproductive Health Library and Zetoc) were searched from 28 October 2010 to 08 December 2010. Cochrane and non- Cochrane systematic reviews were included. Eligible reviews included studies whose participants were sexually active women or men from countries classified as ‘developing’, ‘low-income’ or ‘middle-income’. Systematic reviews of any intervention (or combination of interventions) designed to increase contraceptive prevalence, reduce fertility or both were eligible. Data were extracted and synthesised narratively. A Measurement Tool to Assess Systematic Reviews, AMSTAR, was used to evaluate the quality of the included systematic reviews, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to evaluate the quality of the body of evidence for each comparison. To aid the interpretation of the findings for a variety of settings, relevant contextual information was presented where possible. Results There were 22 systematic reviews included in this overview of reviews. The overview examined a range of contraceptive methods, including modern (terminal and spacing) and traditional methods (such as withdrawal and periodic abstinence which do not require contraceptive substances or devices and also do not require clinical procedures). However, the systematic reviews included did not address all the objectives of the overview. The results of the review are summarised below according to the objectives. Objective 1: To assess the impact of various contraceptive methods and mixes of contraceptive methods on contraceptive prevalence in developing countries/regions. There was no systematic
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