Skip to main content
Download PDF

Pattern of contraceptive use among reproductive-aged women with diabetes and/or hypertension: findings from Bangladesh Demographic and Health Survey

BMC Women's Health volume 22, Article number: 230 (2022) Cite this article

Abstract

Background

The prevalence of chronic conditions such as diabetes and hypertension is increasing among reproductive-aged women in Bangladesh. However, the pattern of contraceptive use among this population remains unknown. We, therefore, explored the pattern of contraceptive use among reproductive-aged women with diabetes and/or hypertension in Bangladesh.

Methods

We extracted and analysed data of 3,947 women from the 2017/18 Bangladesh Demographic and Health Survey. Women’s pattern of contraceptive use was our outcome variable. We first classified the contraceptive using status as no method use, traditional method use (periodic abstinence, withdrawal, other traditional) and modern method use (pill, intra-uterine device, injections, male condom, female sterilization, male sterilization). We later classified these as (i) no contraceptive use vs any contraceptive use, (ii) traditional method or no use vs modern method use, (iii) traditional method vs modern method use. The explanatory variables were diagnosis of diabetes only, hypertension only or both diabetes and hypertension. The multilevel Poisson regression with robust variance was used to explore the associations.

Results

The overall prevalence of contraceptive use was 68.0% (95% CI 66.3–69.7). The corresponding prevalences were 69.4% (95% CI 61.8–76.1) in women with diabetes only, 67.3% (95% CI 63.5–70.9) with hypertension only, and 62.0% (95% CI 52.8–70.4) in women having both diabetes and hypertension. The prevalence of modern methods of contraceptive use was lower (46.4%, 95% CI 37.4–55.6) and traditional methods use was higher (16.6%, 95% CI 13.8–16.8) in women who had both diabetes and hypertension than in women who did not have these conditions. The fully adjusted regression model showed that the prevalence of traditional method use was 31% (Prevalence ratio: 1.31, 95% CI 1.02–2.01) higher in women having both diabetes and hypertension compared with their counterparts who had none of these conditions.

Conclusion

In Bangladesh, women with both diabetes and hypertension were more likely to use traditional contraception methods. These women are likely to experience increased risks of unwanted pregnancies and associated adverse maternal and child health outcomes. Targeted policies and programs should be undertaken to promote modern contraceptive use among women living with both chronic conditions.

Peer Review reports

Introduction

Chronic conditions such as diabetes and hypertension are rising in low- and middle-income countries (LMICs), including Bangladesh [1,2,3]. This rising pattern is even more evident among reproductive-aged women (15–49 years) due to an increasing prevalence of overweight and obesity in younger women [2, 3]. As overweight and obesity are major predictors of being diabetic and hypertensive [4], there is a risk of further rise of diabetes and hypertension among reproductive-aged women in the coming years.

Women with diabetes and hypertension are at increased risk of pregnancy-related complications, including pre-eclampsia, preterm labour, polyhydramnios, and increased operative deliveries [5]. They are also more likely to give birth to babies with congenital anomalies and stillbirths [6]. Moreover, both prediabetes and hypertension are risk factors for gestational diabetes [7, 8]. Studies showed that offspring whose mothers have gestational diabetes are at increased risk of high blood pressure during early childhood [9, 10]. There is also evidence that offspring of mothers with gestational diabetes are predisposed to metabolic syndrome and its components [11,12,13], a pathway to long-term disease burden. Because of these adverse pregnancies and birth outcomes, delaying pregnancies up to the time when mothers controlled these conditions is of utmost importance [14]. Thus, there is an urgency to ensure effective family planning and contraceptive use along with proper management of diabetes and hypertension.

A limited number of studies explored the pattern of contraceptive use among women with diabetes and hypertension in LMICs [15,16,17,18,19,20,21,22], and the findings are inconclusive. The reasons for variation in these findings include the differences in study designs and sample sizes as well as the number of chronic conditions included as explanatory variables[15,16,17,18,19,20,21,22]. Other notable reasons are country-level variation in contraceptive use and difference in policies and programs to deliver contraceptives as part of health care services to manage diabetes and hypertension [22]. Also, pattern of contraceptive use among women with diabetes and hypertension were not compared with women without these chronic conditions [20]. These studies, therefore, offer limited information for formulating population-specific policies and programs for promoting contraception.

Previous studies in Bangladesh and other LMICs reported inadequate management of diabetes and hypertension and a relatively high prevalence of unintended pregnancies (47%) due to using no contraceptives or less effective methods [2, 3, 23,24,25,26,27]. However, there are little data in LMICs, including Bangladesh, about contraceptive use pattern among women with diabetes and/or hypertension. We, therefore, explored the pattern of contraceptive use in reproductive-aged women with and without diabetes and/or hypertension in Bangladesh.

Materials and methods

Study design

We analysed data from the most recent Bangladesh Demographic and Health Survey (BDHS) conducted in 2017/18. The survey was conducted by the DHS program of the USA. The National Institute of Population Research and Training of the Ministry of Health and Family Welfare of Bangladesh worked as a local partner. The survey followed a two-stage stratified random sampling method. In the first stage, 675 primary sampling units (PSUs) were selected randomly from a list of 293,579, which were created as part of the most recent Bangladesh Population and Housing Census. However, the survey could not be conducted in three PSUs due to extreme flooding during the data collection. In the second stage, 20,160 households were selected for data collection, with 30 households chosen from each selected PSU. Of them, the interview was completed in 19,457 households with a 96.5% inclusion rate. There were 20,376 eligible women in these selected households, and data were collected from 20,127 women. Informed consent was obtained from all participants. The contraception data was collected from each of these women. However, diabetes and hypertension-related data were collected from one-fourth of the selected households (7 to 8 households per PSU). Unlike contraception data, diabetes and hypertension data were collected from both males and females aged 18 years and more in the selected households. There were 14,704 respondents in these selected households, 12,924 of them (men: 5,583; women: 7,341) had blood pressure measured and blood glucose tested. Details of the sampling procedure have been published elsewhere [28].

Analytic sample

Data of 3,947 women who met the following inclusion criteria were analysed in this study. The inclusion criteria were: (i) reproductive-aged fertile women who were not pregnant or not in the post-partum amenorrhea period at the time of data collection and (ii) reported their blood pressure and blood glucose or their medication status to control blood pressure and/or blood glucose.

Outcome measures

Based on women’s contraceptive use status (yes, no) and the type of methods they used (e.g., pill, condom, sterilization), we generated three different outcome measures: (i) no contraceptive use vs any contraceptive use (modern or traditional method), (ii) traditional method or no use vs modern method use, (iii) traditional method vs modern method use.

Explanatory variables and confounders

Women’s diabetes and hypertension status were our main explanatory (independent) variables classified as none, diabetes only, hypertension only, and both diabetes and hypertension. Confounders were considered at the individual, household, and community-level factors based on previous relevant literature [2,3,4, 15, 17, 29]. Individual-level factors were women's age (≤ 19 years, 20–34 years, ≥ 35 years), education (no education, primary education, secondary education, higher education) and body mass index (BMI: underweight, normal weight, overweight, obese). We followed the World Health Organization (WHO) recommendation for the Asian population’s body mass index to classify women's BMI in this study [30]. Husband’s education (no formal education, primary education, secondary education, higher education), number of children ever born (no child, 1–2 children, > 2 children) and wealth quintile (poorest, poorer, middle, richer, richest) were the household level factors. The BDHS created the wealth quintile variable using the principal component analysis of women’s responses on the households’ durable goods such as materials to build houses and the ownership of radio/television. Women’s place of residence (urban, rural) and administrative divisions (Barishal, Chattogram, Dhaka, Khulna, Mymensingh, Rajshahi, Rangpur, Sylhet) were community-level factors.

Statistical analysis

We reported frequency and percentage to describe the characteristics of the respondents. The prevalence of contraceptive use in general and across diabetes and hypertension status of the women were calculated and reported with 95% confidence intervals (95% CI). We used multilevel mixed-effect Poisson regression with robust variance to estimate the associations between the outcomes and explanatory variables. We used Poisson regression because the odds ratio using logistic regression in cross-sectional studies may significantly overestimate the effect size when the outcomes are common (e.g., prevalence > 10%) [31, 32]. Secondly, in the dataset, individuals were nested within households; and households were nested within PSUs. This nested data structure generated multiple hierarchies and dependencies. The multilevel mixed-effects Poisson regression accounts for these multiple hierarchies and dependencies in data and the problem of overestimation [33]. We developed unadjusted and adjusted models (adjusted for individual, household, and community level confounders) for each of the three study outcomes. For instance, the first set of models examined the associations between women’s status of chronic conditions and contraceptive use (no use vs any methods use). The second set examined the associations between women’s status of chronic conditions and contraceptive use type (traditional methods/no use vs modern methods use). The third set examined the association with contraception method type (traditional methods vs modern methods use). Sampling weight and complex survey design were considered in all analyses. Results are reported as prevalence ratio (PR) with its corresponding 95% CI. Multicollinearity and interactions were checked. All statistical tests were two-sided, and a p-value < 0.05 was considered statistically significant. The study was designed and reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [34]. All methods were performed in accordance with the relevant guidelines and regulations. All analyses were performed using the statistical software package Stata (version 15.1; Stata Corp LP, College Station, TX, USA).

Results

The study included data from 3,947 women of reproductive age. Participants’ mean (standard deviation) age was 33 (8.86) years (Table 1). Around 20% of women did not receive formal education and 3% were nulliparous. At the time of the survey, over three-fourth of women were living in rural areas. Around half of the women were overweight/obese, 19.9% were hypertensive, 5.2% had diabetes and 3.6% had both diabetes and hypertension.

Table 1 Characteristic of women of reproductive age 15–49 (n = 3947)
Full size table

The prevalence of contraceptive use by women with diabetes and/or hypertension is presented in Table 2. Around 68.0% (95% CI 66.3%—69.7%) of women reported using modern or traditional contraceptives. This percentage was 62.0% (95% CI 52.8%—70.4%) among women who had both diabetes and hypertension, and went down further when examined separately for modern contraceptive methods use (46.4%, 95% CI 37.4%—55.6%). The prevalence of modern contraceptive use was 56.4% (95% CI 48.5%—63.9%) among women with diabetes, 54.4% (95% CI 50.3%—58.4%) among women with hypertension and 46.4% (95% CI 37.4%—55.6%) among women who had both diabetes and hypertension.

Table 2 Pattern of contraceptive use in Bangladesh, BDHS 2017–2018
Full size table

Among modern contraceptives, oral contraceptive pills (27.2%, 95% CI 25.6%—28.9%) and injectables (12.4%, 95% CI 11.2%—13.7%) were dominant methods in all women as well as in women with diabetes only, hypertension only, or both diabetes and hypertension. The use of traditional contraceptive methods increased from 11.1% (95% CI 9.1%—12.4%) among all women to 15.6% (95% CI 13.8%—16.8%) among women who had both diabetes and hypertension.

Unadjusted and adjusted associations between contraceptive use and diabetes and/or hypertension generated from multiple mixed-effect Poisson regression models are reported in Table 3. Unadjusted models show that women with both diabetes and hypertension were significantly more likely than women who had none of these conditions to report using traditional methods or no contraceptives (PR: 1.29, 95% CI 1.08–1.53; p = 0.005). Women who had hypertension only (PR: 1.30, 95% CI 1.04–1.62; p = 0.021) or had both diabetes and hypertension (PR: 1.70, 95% CI 1.14–2.52; p = 0.008) were significantly more likely than their counterparts to report using traditional methods of contraception.

Table 3 Unadjusted and adjusted associations between types of contraceptives use and women with diabetes and/or hypertension
Full size table

When models were adjusted for women’s age, education, BMI, husbands’ education, wealth quintiles, number of children, place of residence and administrative divisions, most of the associations reported in the unadjusted disappeared except for the traditional contraceptive use. We found a 31% (aPR: 1.31, 95% CI: 1.02–2.01) higher prevalence of traditional contraceptive methods use among women who had both diabetes and hypertension compared with women who did not have diabetes or hypertension.

Discussion

In this study of a nationally representative sample of 3,947 reproductive-aged women, the prevalence of modern and traditional contraceptive use was 58% and 30%, respectively. The use of modern contraceptives was lower while traditional and non-use of contraception were higher in women with diabetes and/or hypertension. Following the adjustment of individual-, household-, and community-level factors, the prevalence of traditional contraceptive method use was 31% higher in women who had both diabetes and hypertension compared with women who had none of these conditions. To the best of our knowledge, this is a novel finding for Bangladesh and other LMICs. As traditional contraceptive methods increase the risk of unintended pregnancy, adverse pregnancy and birth outcomes, these study findings have policy implications about ensuring the use of modern contraception methods in women with chronic conditions, especially those who have both diabetes and hypertension.

Although our study found a relatively low prevalence of hypertension (20%) and diabetes (5%) compared to the national prevalence (27.4% and 9.8%, respectively) among women [2, 3], the rate of diabetes and hypertension in women of reproductive age is gradually increasing in Bangladesh [2, 3, 28]. These chronic conditions have a range of adverse consequences; for instance, hypertensive disorders are the third major cause of maternal mortality in LMICs [35]. The consequences could be aggravated further if women have both diabetes and hypertension and much of these adverse consequences are preventable by ensuring planned pregnancies [14]. However, this is quite challenging in Bangladesh and other LMICs, because of the low prevalence of contraceptive use, financial difficulties, and misunderstanding and/or misconception associated with pregnancies among women with diabetes and/or hypertension [20, 24]. Well-designed programs are needed for effective management of diabetes and hypertension along with appropriate family planning services to delay pregnancies until women are ready for conception [36].

Around 32% of women in our study did not use contraception and 11% depended on traditional contraceptive methods. Previous studies identified several reasons for such high levels of traditional contraceptive use or no contraceptive use, including (i) lack of awareness of the importance of contraceptive use, (ii) difficulties in accessing contraceptives from government-run sources, and (ii) financial difficulties in accessing contraceptives from private sources, or combinations of these factors [24, 37]. Religious directives that Islam (religion of over 90% of people in Bangladesh) does not permit contraceptive use is also a common barrier to the access and use of contraception [24]. The cumulative effects could worsen the situation for women with diabetes and hypertension, as the findings of our study suggest. The effective management of diabetes and hypertension needs continuous treatment, medication and visits to healthcare facilities [38]. These requirements can create economic burdens because management care for diabetes and hypertension is mainly available at private healthcare facilities, which are generally expensive [3]. Additional expenses associated with modern contraceptive use could be a further barrier. Moreover, the healthcare facilities that provide care for the management of diabetes and hypertension are usually separate from the healthcare facilities that deliver family planning services [39]. Women may not receive counselling for contraceptive use due to the exclusive focus on the management of diabetes and hypertension [39]. These fragmented services affect women’s knowledge of the importance of using effective contraception and the risk of becoming pregnant until they have controlled chronic conditions. Bangladesh should prioritize initiatives to ensure contraception counselling and distribution as part of diabetes and hypertension management care [40,41,42].

Literature suggests that selective modern contraceptive methods, e.g. progestin-only contraceptives and condom use, are suitable for women with diabetes and hypertension [22]. However, misunderstandings are common; for instance, a significant percentage of women generally believe that contraceptive use elevates blood glucose and blood pressure [43,44,45,46]. Another misapprehension is that chronic diseases may reduce women’s fertility, and thereby effective contraceptive use is considered unnecessary [15, 47]. Intrauterine and vaginal devices are considered risky for women with diabetes and hypertension, as they need to be inserted through surgical operation. Moreover, women with chronic conditions who desire pregnancy may not be sure of the appropriate timing because of their inadequate knowledge of whether conception would put them at risk [15, 17]. This ambivalence about timing is associated with no use or the use of traditional contraceptive methods [24]. It is also possible that women with uncontrolled diabetes and hypertension are sexually less active and thus do not use contraceptives [20]. Besides, as there are some potential risks of using hormonal contraception in certain patients with metabolic syndrome, fear of exacerbating the disease may prevent some clinicians from recommending contraception [48]. Moreover, one potential misunderstanding among many providers is that women with a medical condition cannot take estrogen [49], which might be conducive in Bangladesh. These misunderstandings are additional for the women with diabetes and hypertension to the common community level general misunderstandings about contraception use, e.g. contraception use can cause uterine fibroids, cancer, infertility, and birth defects [50]. Our results could be a confluence of all these factors. While further research is needed to identify the reasons for low use of modern contraceptive, our findings suggest the need for targeted policies and programs to promote appropriate contraceptive use by women with chronic conditions.

The current study has several strengths. We analyzed a large nationally representative dataset and thus our findings are likely to be generalisable in Bangladesh and other countries of similar features. Also, diabetes and hypertension were measured using high-quality techniques and we classified them following the WHO guidelines. The BMI was classified following the WHO recommendation for the Asian population. The analytical approach we used considered the hierarchical structure of the data and avoided the chance of effect-size overestimation that may occur if conventional logistic regression is employed in cross-sectional studies. We adjusted the regression models for a wide range of potential confounding factors. This study also has some limitations. As we analysed cross-sectional data, the findings are correlational only. Another limitation was possible reporting bias in diabetes and hypertension status, which were self-reported. However, any such reporting error is likely to be random. We recommend prospective cohort data for future studies of contraceptive use in women with chronic conditions, including diabetes and hypertension.

Conclusion

In Bangladesh, women with both diabetes and hypertension were more likely to use traditional contraceptive methods. These women are likely to experience increased risks of unwanted pregnancies and associated adverse maternal and child health outcomes. Targeted policies and programs should be undertaken to promote modern contraceptive use among women diagnosed with both of these chronic conditions. Contraception should also be included in diabetes and hypertension care management for reproductive-aged women.

Availability of data and materials

The data that support the findings of this study are available from The DHS Program, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of The DHS Program (https://dhsprogram.com/data/).

Abbreviations

LMICs:

Low- and middle-income countries

BDHS:

Bangladesh Demographic and Health Survey

NIPORT:

National institute of population research and training

WHO:

World Health Organization

PR:

Prevalence ratio

PSU:

Primary sampling unit

References

  1. Sarki AM, Nduka CU, Stranges S, Kandala N-B, Uthman OA: Prevalence of hypertension in low-and middle-income countries: a systematic review and meta-analysis. Medicine 2015, 94(50).

  2. Khan MN, Oldroyd JC, Chowdhury EK, Hossain MB, Rana J, Islam RM: Prevalence, awareness, treatment, and control of hypertension in Bangladesh: Findings from National Demographic and Health Survey, 2017–18. medRxiv 2021.

  3. Islam R, Khan MN, Oldroyd JC, Rana J, Chowdhury EK, Karim MN, Hossain MB: Prevalence of diabetes and prediabetes among Bangladeshi adults and associated factors: Evidence from the Demographic and Health Survey, 2017–18. medRxiv 2021.

  4. Patel SA, Ali MK, Alam D, Yan LL, Levitt NS, Bernabe-Ortiz A, Checkley W, Wu Y, Irazola V, Gutierrez L. Obesity and its relation with diabetes and hypertension: a cross-sectional study across 4 geographical regions. Global heart. 2016;11(1):71–9.

    Article  PubMed  Google Scholar 

  5. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–33.

    Article  PubMed  Google Scholar 

  6. Mackin ST, Nelson SM, Wild SH, Colhoun HM, Wood R, Lindsay RS. Factors associated with stillbirth in women with diabetes. Diabetologia. 2019;62(10):1938–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Hedderson MM, Ferrara A. High blood pressure before and during early pregnancy is associated with an increased risk of gestational diabetes mellitus. Diabetes Care. 2008;31(12):2362–7.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Pons RS, Rockett FC, de Almeida Rubin B, Oppermann MLR, Bosa VL: Risk factors for gestational diabetes mellitus in a sample of pregnant women diagnosed with the disease. In: Diabetology & metabolic syndrome: 2015: BioMed Central; 2015: 1–2.

  9. Lu J, Zhang S, Li W, Leng J, Wang L, Liu H, Li W, Zhang C, Qi L, Tuomilehto J. Maternal gestational diabetes is associated with offspring’s hypertension. Am J Hypertens. 2019;32(4):335–42.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Miranda JO, Cerqueira RJ, Barros H, Areias JC. Maternal diabetes mellitus as a risk factor for high blood pressure in late childhood: a prospective birth cohort study. Hypertension. 2019;73(1):e1–7.

    Article  CAS  PubMed  Google Scholar 

  11. Zhang S, Liu H, Zhang C, Wang L, Li N, Leng J, Li Y, Liu G, Fan X, Yu Z: Maternal glucose during pregnancy and after delivery in women with gestational diabetes mellitus on overweight status of their children. BioMed research international 2015, 2015.

  12. Tam WH, Ma RCW, Ozaki R, Li AM, Chan MHM, Yuen LY, Lao TTH, Yang X, Ho CS, Tutino GE. In utero exposure to maternal hyperglycemia increases childhood cardiometabolic risk in offspring. Diabetes Care. 2017;40(5):679–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles M-A, Pettitt DJ. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care. 2007;30(9):2287–92.

    Article  PubMed  Google Scholar 

  14. Association AD. Management of diabetes in pregnancy: standards of medical care in diabetes—2019. Diabetes Care. 2019;42(Supplement 1):S165–72.

    Article  Google Scholar 

  15. Chuang CH, Chase GA, Bensyl DM, Weisman CS. Contraceptive use by diabetic and obese women. Womens Health Issues. 2005;15(4):167–73.

    Article  PubMed  Google Scholar 

  16. Perritt JB, Burke A, Jamshidli R, Wang J, Fox M. Contraception counseling, pregnancy intention and contraception use in women with medical problems: an analysis of data from the Maryland Pregnancy Risk Assessment Monitoring System (PRAMS). Contraception. 2013;88(2):263–8.

    Article  PubMed  Google Scholar 

  17. Vahratian A, Barber JS, Lawrence JM, Kim C. Family-planning practices among women with diabetes and overweight and obese women in the 2002 National Survey For Family Growth. Diabetes Care. 2009;32(6):1026–31.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Harris M, Egan N, Forder PM, Bateson D, Sverdlov AL, Murphy VE, Loxton D: Patterns of contraceptive use among young Australian women with chronic disease: findings from a prospective cohort study. 2021.

  19. Nojomi M, Morrovatdar N, Davoudi F, Hosseini S. Contraceptive use by Iranian women with hypertension, diabetes or obesity. EMHJ-Eastern Mediterranean Health J. 2013;19(7):638–43.

    Article  CAS  Google Scholar 

  20. Mekonnen TT, Woldeyohannes SM, Yigzaw T. Contraceptive use in women with hypertension and diabetes: cross-sectional study in northwest Ethiopia. Int J Women’s Health. 2015;7:957.

    Google Scholar 

  21. Afshari M, Alizadeh-Navaei R, Moosazadeh M. Oral contraceptives and hypertension in women: results of the enrolment phase of Tabari Cohort Study. BMC Womens Health. 2021;21(1):1–7.

    Article  Google Scholar 

  22. Robinson A, Nwolise C, Shawe J. Contraception for women with diabetes: challenges and solutions. Open Access J Contracept. 2016;7:11.

    Article  PubMed  PubMed Central  Google Scholar 

  23. KHAN MN: Effects of Unintended Pregnancy on Maternal Healthcare Services Use in Bangladesh. Faculty of Health and Medicine, School of Medicine and Public Health, The …; 2020.

  24. Khan MN, Harris M, Loxton D. Modern contraceptive use following an unplanned birth in Bangladesh: an analysis of national survey data. Int Perspect Sex Reprod Health. 2020;46:77–87.

    Article  PubMed  Google Scholar 

  25. Khan MN, Islam MM. Exploring rise of pregnancy in Bangladesh resulting from contraceptive failure. Sci Rep. 2022;12(1):1–10.

    Article  Google Scholar 

  26. Bishwajit G, Tang S, Yaya S, Feng Z. Unmet need for contraception and its association with unintended pregnancy in Bangladesh. BMC Pregnancy Childbirth. 2017;17(1):1–9.

    Article  Google Scholar 

  27. Huda FA, Chowdhuri S, Robertson Y, Islam N, Sarker BK, Azmi AJ, Reichenbach L: Understanding unintended pregnancy in Bangladesh: country profile report. 2013.

  28. NIPORT MaA, ICF International, : Bangladesh Demographic and Health Survey, 2017/18. In. NIPORT, Mitra & Associates and ICF International, Dhaka, Bangladesh and Calverton, MD, USA2013.; 2020.

  29. Greydanus DE, Omar HA, Tsitsika A: Obesity and contraception. 2009.

  30. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet (London, England). 2004;363(9403):157–63.

    Article  Google Scholar 

  31. Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3(1):1–13.

    Article  Google Scholar 

  32. Tamhane AR, Westfall AO, Burkholder GA, Cutter GR. Prevalence odds ratio versus prevalence ratio: choice comes with consequences. Stat Med. 2016;35(30):5730–5.

    PubMed  PubMed Central  Google Scholar 

  33. O'Connell AA, McCoach DB: Multilevel modeling of educational data: IAP; 2008.

  34. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Bull World Health Organ. 2007;85:867–72.

    Article  Google Scholar 

  35. World Health Organization: Maternal mortality. In. Geneva, Switzarland The World Health Organization 2021.

  36. Buchanan TA, Xiang AH, Page KA. Gestational diabetes mellitus: risks and management during and after pregnancy. Nat Rev Endocrinol. 2012;8(11):639.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Khan MN, Islam MM, Akter S: Availability and readiness of healthcare facilities and their effects on long-acting modern contraception use in Bangladesh: Analysis of linked data. medRxiv 2021.

  38. Beaglehole R, Epping-Jordan J, Patel V, Chopra M, Ebrahim S, Kidd M, Haines A. Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care. The Lancet. 2008;372(9642):940–9.

    Article  Google Scholar 

  39. National Institute of Population Research and Training (NIPORT) and ICF: Bangladesh Health Facility Survey 2017. In. Dhaka, Bangladesh: NIPORT, ACPR, and ICF.; 2019.

  40. Ahmad A, Oparil S. Hypertension in women: recent advances and lingering questions. Hypertension. 2017;70(1):19–26.

    Article  CAS  PubMed  Google Scholar 

  41. Schwarz EB, Postlethwaite D, Hung Y-Y, Lantzman E, Armstrong MA, Horberg MA. Provision of contraceptive services to women with diabetes mellitus. J Gen Intern Med. 2012;27(2):196–201.

    Article  PubMed  Google Scholar 

  42. Marshall CJ, Huma Z, Deardorff J, Britton LE. Prepregnancy counseling among US Women with diabetes and hypertension, 2016–2018. Am J Prev Med. 2021;61(4):529–36.

    Article  PubMed  Google Scholar 

  43. Pallardo L, Cano A, Cristobal I, Blanco M, Lozano M, Lete I: Hormonal contraception and diabetes. Clinical Medicine Insights: Women's Health 2012, 5:CMWH. S9934.

  44. Endriyas M, Eshete A, Mekonnen E, Misganaw T, Shiferaw M. Where we should focus? Myths and misconceptions of long acting contraceptives in Southern Nations, Nationalities and People’s Region, Ethiopia: qualitative study. BMC Pregnancy Childbirth. 2018;18(1):1–6.

    Article  Google Scholar 

  45. Medical News Today: Debunking common birth control myths. In.; 2020.

  46. Ochako R, Mbondo M, Aloo S, Kaimenyi S, Thompson R, Temmerman M, Kays M. Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study. BMC Public Health. 2015;15(1):1–9.

    Article  Google Scholar 

  47. Kersten I, Lange AE, Haas JP, Fusch C, Lode H, Hoffmann W, Thyrian JR. Chronic diseases in pregnant women: prevalence and birth outcomes based on the SNiP-study. BMC Pregnancy Childbirth. 2014;14(1):1–13.

    Article  Google Scholar 

  48. Lykens JE, Broecker JE. Contraceptive options for women with metabolic syndrome. Osteopathic Family Physician. 2011;3(3):88–98.

    Article  Google Scholar 

  49. Lathrop E, Jatlaoui T. Contraception for women with chronic medical conditions: an evidence-based approach. Clin Obstet Gynecol. 2014;57(4):674–81.

    Article  PubMed  Google Scholar 

  50. Adongo PB. Tabong PT-N, Azongo TB, Phillips JF, Sheff MC, Stone AE, Tapsoba P: A comparative qualitative study of misconceptions associated with contraceptive use in southern and northern Ghana. Front Public Health. 2014;2:137.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors thank the MEASURE DHS for granting access to the 2017/18 BDHS data.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal Mymensingh, 2220, Bangladesh

    Md Nuruzzaman Khan

  2. Department of Public Health, La Trobe University, Melbourne, Australia

    M. Mofizul Islam

  3. School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

    Rakibul M. Islam

  4. South Asian Institute for Social Transformation (SAIST), Dhaka, Bangladesh

    Rakibul M. Islam

Authors
  1. Md Nuruzzaman Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Mofizul Islam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rakibul M. Islam
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Khan MN and Islam MM designed the study. Khan MN performed the data analysis with the help of Islam MM and Islam RM. Khan MN wrote the first draft of this manuscript. Islam RM and Islam MM critically reviewed and edited the previous versions of this paper. All authors approved this final version of the paper.

Corresponding author

Correspondence to Md Nuruzzaman Khan.

Ethics declarations

Ethics approval and consent to participate

The survey analysed was approved by the institutional review board of ICF and the National Research Ethics Committee of the Bangladesh Medical Research Council. Informed consent was obtained from all participants by the DHS before data collection. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. No separate ethical approval was required to conduct this study. We obtained permission from MEASURE DHS (BDHS data custodian) to access this survey and conduct this research. All methods were performed in accordance with the relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khan, M.N., Islam, M.M. & Islam, R.M. Pattern of contraceptive use among reproductive-aged women with diabetes and/or hypertension: findings from Bangladesh Demographic and Health Survey. BMC Women's Health 22, 230 (2022). https://doi.org/10.1186/s12905-022-01822-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12905-022-01822-x

Keywords

BMC Women's Health

ISSN: 1472-6874

Contact us