ABSTRACTThis study is the first of a series of community-based surveys that the City of TshwaneMetropolitan Municipality (CTMM) has planned to conduct in the next 15 years to fulfill itsprovincial mandate (being the provider of primary health care services) in accordance with theGauteng District Health Services Act (Act No 8 of 2000)1. The study determined the prevalencerate of contraceptive use and method choice, and the effects of the availability of reproductivehealth 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 withprobability proportional to size to determine these effects. A modified 1998 SADHSquestionnaire helped to collect information on selected individuals, programmes and districtexplanatory variables from women living in the four health sub-districts and data were used inthree B (4 variables), C (six variables) and D (eight variables) unconditional binary logisticregression models and a multinomial logistic model to estimate their effects (odds ratios and pvalueat 5% level) on contraceptive use and method choice. The selection of these variables isbased on the conceptual framework that recognizes that contraceptive use or method choice is theconsequence of service utilization, which, in turn, is influenced by individual, service/programmeand community factors2,3. The availability of reproductive health services was measured by thepresence 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 theprogrammatic variables was independently associated with contraceptive use. By contrast,district/place of residence predictor was associated with reduced odds of contraceptive use andwith reduced odds of condom, injection and IUD’s choice against pill in all the models anddistricts, respectively. In terms of the source of first information on contraceptive methods andthe 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 (oddsratio, 0.65, p<0.05) are shown to be less likely than mothers to be the providers of information oninjection as opposed to the pill. The private sector ( odds ratio, 2.12, p<0.01) is shown to be morelikely than the public sector to be the supply source of IUD methods rather than the pill, and alsomore likely (odds ratio, 1.97, p<0.01) than the public sector to be the supply source of IUDinstead of injection. Private pharmacies (odds ratio, 2.25, p<0.05) are more likely than the publicsector to supply condoms rather than the pill.The presence or absence of reproductive health services in a district was significantly associatedwith reduced odds of both contraceptive use and choice of condom, injection and IUD methodsagainst pill. This may be attributable to women’s willingness to travel outside their place ofresidence to get their preferred method. Thus availability of reproductive health services in thedistrict seems not to have an important effect on use and choice of modern contraception in the City of Tshwane in 2004.
