We will investigate two interrelated questions: why women choose Norplant over other methods of contraception, and why some women become dissatisfied with the method and discontinue its use. We will interview three groups: women choosing Norplant (N=1508); those choosing another reversible method over Norplant (N=300), and those selecting sterilization over Norplant (N=300). The Norplant sample will be re-interviewed at 3 months and 2.5 years post-insertion. Discontinuers will be interviewed within two weeks of removal. Women will be selected from clinics. in New York City, Pittsburgh, and Dallas and the sample will include blacks, whites and Hispanics.
The specific aims of the study are to: (1) Describe the expectations and beliefs about Norplant held by women who do and do not choose the method. (2) Test an integrative model of the determinants of Norplant use, the central element of which is the expected-value of Norplant choice. The other elements of the model are: fertility and contraceptive history; health care provider influences; background and sociodemographic characteristics; and partners' attitudes regarding fertility and Norplant use. (3) Describe the presence and intensity of Norplant side effects. (4) Specify how women's experiences with Norplant relate to the expectations they held prior to Norplant insertion. (5) Test a model of Norplant dissatisfaction and discontinuation, a central element of which is the discrepancies between expectations regarding Norplant and actual experiences with the method. Other key elements in the model are: changes in respondents' relationship status and fertility desires; partners' fertility and Norplant attitudes; and provider-based and economic barriers to discontinuation. (6) Identify the conditions under which dissatisfaction leads to discontinuation. This study extends our knowledge in several ways. First, it represents the first systematic inquiry into Norplant decision making, and provides comprehensive information regarding the relationship between women's expectations about and experiences with a broad spectrum of Norplant outcomes. Second, it develops an integrated framework of method use that weaves together more traditional social psychological determinants with structural and sociodemographic influences' Finally, it provides one of the first theoretically driven studies of contraceptive discontinuation.
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| Kalmuss, D; Davidson, A R; Cushman, L F et al. (1996) Determinants of early implant discontinuation among low-income women. Fam Plann Perspect 28:256-60 |
