Monitoring Contraceptive Continuation: Links to Fertility Outcomes and Quality of Care

TLDR

The study investigates how contraceptive discontinuation affects fertility, maps cross‑national variation in continuation rates, and evaluates the discontinuation rate as a potential quality‑of‑care metric. Across 15 countries, discontinuation contributed to a 28–64 % reduction in total fertility, with 7–27 % of users stopping within a year for quality‑related reasons, indicating that the all‑method discontinuation rate is a promising quality metric and that programs should focus on reducing discontinuation rather than merely expanding method provision.

Abstract

This study examines the fertility consequences of contraceptive discontinuation, describes cross‐national variation in continuation rates, and assesses the usefulness of the contraceptive discontinuation rate as a summary outcome indicator of quality of care. In the 15 countries included in this analysis, the total fertility rate would be between 28 and 64 percent lower if the births following discontinuations that were not the result of a desire to become pregnant had not occurred. The all‐method discontinuation rate for quality‐related reasons emerges as the most likely candidate for a summary measure of quality of care. Within a year of starting use of a method, between 7 and 27 percent of women cease to practice contraception for reasons related to the quality of the service environment. The results imply that as fertility declines, family planning programs would profit from a shift in emphasis from providing methods to new clients toward providing services to reduce discontinuation rates.