Abstract
Objectives
Covert contraceptive use (CCU) is the use of family planning without a partner's knowledge.
This study sought to examine CCU prevalence among women living in Rakai, Uganda, predictors
of CCU, and why women resort to CCU.
Study Design
We used data from women (15–49 years) currently using contraceptives (oral contraceptives, Depo Provera, implants,
intrauterine devices, and periodic abstinence) during Round 15 (2011–2013) of the
Rakai Community Cohort Survey (n=2206). We utilized logistic regressions to analyze
the association between self-reported CCU and current contraceptive method, sexual
activity, experience of violence, and demographic data. We also used data from in-depth
interviews (IDI) on HIV and reproductive health conducted in 2013–2016.
Results
CCU prevalence was 26%. In the multivariable model, being previously married (aOR=2.2
[1.7–2.9]), having no formal education (aOR=2.1 [1.1–3.9]), and experiencing physical
violence (aOR=1.7 [1.3–2.2]) or having more than 1 sex partner (aOR=1.6 [1.2–2.2])
in the past 12 months were CCU predictors. Advancing past primary school decreased the odds of CCU
(aOR=0.7 [0.6–0.9]). HIV was positively associated with CCU in the unadjusted model,
but not the adjusted. In the IDIs, women primarily resorted to CCU because of discordant
fertility desires—coupled with financial insecurity, negative stereotypes towards
contraceptives use, deteriorating health, and familial pressure to reproduce. One
woman employed CCU because she feared being ostracized from her community.
Conclusions
CCU is common amongst users of contraception and is used to hide family planning from
partners and communities. Women that diverge from Uganda's cultural norms had higher
odds of CCU.
Implications
Clinicians and practitioners should be aware of CCU among their patients and should
educate women on the wide variety of contraceptive methods to help them decide if
their current covert method is best for their health and safety.
Keywords
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Article info
Publication history
Published online: March 04, 2018
Accepted:
February 28,
2018
Received in revised form:
February 28,
2018
Received:
September 9,
2017
Identification
Copyright
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