Differences by Residence and Education In Contraceptive Failure Rates in Developing Countries

Abstract

The Demographic and Health Survey data were derived from nationally representative samples of currently married women of reproductive age in 9 Latin American 3 Asian and 3 North African populations. Contraceptive prevalence was highest in Thailand with more than two-thirds of married women aged 14-49 using a contraceptive method and lowest in Guatemala with fewer than one-quarter of married women aged 15-44 using a method. The analysis examined life-table probabilities of use failure. The number of contraceptive use segments included in the life-table calculations ranged from 541 in Guatemala to 4157 in Indonesia. A multivariate model was used to measure the likelihood of contraceptive failure of 7 methods: oral contraceptives (OCs) IUD injections and implants vaginal methods condom rhythm and other. The median first-year failure rates were 6% for clinical methods 16% for barrier methods and 18% for traditional methods. Failure rates among urban women for all methods ranged from 2.8 in Indonesia to 15.8 in Guatemala. Among rural women the lowest failure rate was 2.3 in Thailand and the highest was 27.7 in Bolivia. In Colombia the failure rate for each of the method groups among the most educated women was zero. In guatemala failure rates for clinical methods were higher than 10% among women with secondary or higher education and among rural women. The relative risks of contraceptive failure for each country derived from the main effects hazard model showed that the risk was lower among women who used the IUD than among OC users in all countries except Brazil. The relative risk of failure for the condom was greater than 1.0 in all countries except Guatemala. In all countries except the Dominican Republic women aged 25 or older were at lower risk of experiencing a contraceptive failure than were those younger than 25. The study showed that the contraceptive method selected the duration of use and the age of the woman are important determinants of the probability of failure in the first year.