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.

Heather Mackenzie, Amy Drahota, Saseendran Pallikadavath, William Stones, Taraneh Dean, Carole Fogg, Rebecca Stores, Sally Kilburn, Ann Dewey, Reuben Ogollah

Research output: Book/ReportCommissioned report

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 review that met this objective.

Objective 2:
To assess the impact of various contraceptive methods and mixes of
contraceptive methods on unwanted and unintended pregnancies in developing
countries/regions. The body of evidence for the relative efficacy or effectiveness
of a variety of contraceptive methods to prevent pregnancy in developing countries was generally rated as of low or moderate quality. There was, however,
a number of comparisons (between different derivatives of the same contraceptive methods) for which the evidence was rated as of high or moderate quality.

Evidence from systematic reviews is lacking on the acceptability of contraceptive methods and their impact on prevalence and on unmet needs
for family planning. The evidence for the relative effectiveness of a variety of contraceptive methods to prevent pregnancy in developing countries is generally
of low quality. There is some high-quality evidence comparing different derivatives of the same contraceptive methods, although this is more often evidence of efficacy than evidence of effectiveness.
Objective 3:
To assess the impact of various contraceptive methods and mixes of
contraceptive methods on unmet need for family planning in developing
countries/regions. There was no systematic review that met this objective.

Limitations and conclusions
This overview of reviews could not identify any systematic reviews that could
answer all the questions set out in the protocol, particularly those related to
outcomes such as contraceptive prevalence and unmet need for contraception.
This indicates lack of evidence either in the form of systematic reviews or in primary research. Thus, this overview of reviews points out the need to either
undertake systematic reviews or RCTs (where these are possible) or non-
RCT/observational studies (where RCTs are not possible). The overview of reviews, however, did provide an opportunity to compare the effectiveness of various contraceptive methods on outcome measures such as pregnancy and continuation. However much of the available evidence in this area is based on a limited number of poorly conducted studies comparing different formulations of
the same type of contraceptive; there is a lack of evidence from well-designed
studies comparing different types of contraceptives in developing country settings across a wider range of outcomes (e.g. to include birth spacing and unmet need for family planning). It was not possible to present evidence on the included outcomes for a number of types of contraception: male condoms, female condoms, diaphragms, vasectomy, skin patches and vaginal rings.
The evidence examining traditional methods was particularly weak.
Original languageEnglish
Place of PublicationLondon
PublisherEPPI - Centre, Social Science Research Unit, Institute of Education, University of London
Number of pages155
ISBN (Electronic)978-1-907345-61-6
Publication statusPublished - 2013

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