Who uses covertly and what is the impact on contraceptive dynamics? Evidence from a national cohort of women in Uganda

Background: Little is known regarding the specific role of covert use (i.e., contraception without partner knowledge) in contraceptive discontinuation and switching. Among a nationally representative cohort women Uganda, we sought to: 1) compare characteristics covert, overt, non-users at baseline; 2) assess effect using covertly on switching over one-year period. Methods: Analyses utilized PMA2020 Uganda Round 6 (April–May 2018), with longitudinal analyses incorporating data from follow-up survey (May–June 2019). Both cross-sectional (n=1,764) (n=616) samples included need contraception. For analyses, multinomial regression compared risk overt/covert vs. non-use by user logistic odds overt among users. examined baseline status. Results: users, 14.1% reported covertly. In higher wealth (aRRR=1.74; 95% CI=1.19-2.54), secondary or education (aRRR=2.52; CI=1.42-4.49), middle parity (aRRR=1.24; CI=1.00, 2.28) were associated an increased use, (aRRR=2.08; CI=1.09-3.98) polygyny (aRRR=1.60; CI=1.01-2.54) to non-use. Among within polygynous unions had double those monogamous partners (aOR=1.97; CI=1.28-3.03). Longitudinal revealed large proportions users switched (30% 26% covert) discontinued methods (32% 37% follow-up, however, neither nor was significantly related status baseline. Conclusions: Though significant differences not detected, approximately 33% one year; these represent important beneficiaries family planning programming as they may remain for unintended pregnancy.