Results from the 1988 Egypt Demographic and Health Survey show that many women are not taking oral contraceptives in a manner that ensures full protection by the method. Reports from 1,258 current pill users show a range of incorrect use; 63 percent of women surveyed reported an interruption in their use of the pill in the past month, and of those women, only 40 percent took the correct action when they missed a pill. The majority (89 percent) did not wait the correct number of days between packs. Multivariate analysis revealed that rural women were more likely to take pills out of sequence, compared with their urban counterparts. Failure to take a pill within the previous month was strongly associated with the experience of side effects. The younger women surveyed were more likely to know the correct interval between pill packs than were older women; and women who wanted more children were more likely to know the correct interval than those who did not. The use patterns exhibited by the pill users may be the result of their receiving confusing, incorrect, or incomplete information, and highlight the need to provide women with accurate, updated, and comprehensible information about oral contraceptives.
PIP: The results of the 1988 Egypt Demographic and Health Survey showed that misuse of oral contraceptives was higher by four times when the source was the government. Users took pills out of sequence. Further follow-up is needed because of the small sample sizes and lack of information on differences in packaging, counseling, knowledge, or other psychosocial factors. Results also indicated that women who were uneducated were more likely than educated women to take pills out of sequence. Confounding beliefs that the pill need only be used when sperm were present may have been responsible. Support was given to prior findings that there was a strong association between occurrence of side effects and discontinuation of use. This practice was explained as possibly related to the belief that the body needed a "rest" and the misunderstanding that breakthrough bleeding was a resumption of menses, which would necessitate stopping pill taking. Women reported having missed taking pills without becoming pregnant, which reinforced the idea that pills need not be taken sequentially. Findings also indicated that pills were taken more consistently and correctly, when husbands or some else secured the product for the client. An important finding was that almost all had poor knowledge of the correct interval to wait before resuming pill use between cycles. A study by Abou-Bakr found that family planning training was variable, and counseling was not directed to the level of knowledge, understanding, or concerns of clients. Clients also relied heavily on the printed instructions/inserts provided with the supplies. The sample included 8911 ever married women aged 15-49 years, and a subsample of 1258 current oral contraceptive users. Oral contraceptive users were 59% urban and had a mean number of 4 children. 44% had no education. 28% of husbands had no education. Pill use averaged 2 years and ranged from 2 months to 22 years. 91% used 21 day cycle pills. Logistic regression models were used to analyze incorrect pill use.