ABSTRACT
This study is the first of a series of community-based surveys that the City of Tshwane
Metropolitan Municipality (CTMM) has planned to conduct in the next 15 years to fulfill its
provincial mandate (being the provider of primary health care services) in accordance with the
Gauteng District Health Services Act (Act No 8 of 2000)1. The study determined the prevalence
rate of contraceptive use and method choice, and the effects of the availability of reproductive
health services on contraceptive use and method choice in the CTMM in 2004.
The study used a descriptive cross-sectional population-based study design and a sample of 3,
547 women of childbearing age (15-49 years) using a multi-stage cluster sampling with
probability proportional to size to determine these effects. A modified 1998 SADHS
questionnaire helped to collect information on selected individuals, programmes and district
explanatory variables from women living in the four health sub-districts and data were used in
three B (4 variables), C (six variables) and D (eight variables) unconditional binary logistic
regression models and a multinomial logistic model to estimate their effects (odds ratios and pvalue
at 5% level) on contraceptive use and method choice. The selection of these variables is
based on the conceptual framework that recognizes that contraceptive use or method choice is the
consequence of service utilization, which, in turn, is influenced by individual, service/programme
and community factors2,3. The availability of reproductive health services was measured by the
presence or absence of the supply source of contraceptive methods in a district.
After controlling for the effects of individual (social and demographic) variables, none of the
programmatic variables was independently associated with contraceptive use. By contrast,
district/place of residence predictor was associated with reduced odds of contraceptive use and
with reduced odds of condom, injection and IUD’s choice against pill in all the models and
districts, respectively. In terms of the source of first information on contraceptive methods and
the differences between IUD and injection, the study shows that nurses (odds ratio, 1.80, p<0.05)
are more likely than mothers to be the providers of information on IUD while physicians (odds
ratio, 0.65, p<0.05) are shown to be less likely than mothers to be the providers of information on
injection as opposed to the pill. The private sector ( odds ratio, 2.12, p<0.01) is shown to be more
likely than the public sector to be the supply source of IUD methods rather than the pill, and also
more likely (odds ratio, 1.97, p<0.01) than the public sector to be the supply source of IUD
instead of injection. Private pharmacies (odds ratio, 2.25, p<0.05) are more likely than the public
sector to supply condoms rather than the pill.
The presence or absence of reproductive health services in a district was significantly associated
with reduced odds of both contraceptive use and choice of condom, injection and IUD methods
against pill. This may be attributable to women’s willingness to travel outside their place of
residence to get their preferred method. Thus availability of reproductive health services in the
district seems not to have an important effect on use and choice of modern contraception in the City of Tshwane in 2004.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/6112 |
| Date | 13 February 2009 |
| Creators | Tshibangu, Delphin-Cyrille |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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