Contraceptive Discontinuation in Six Developing Countries: A Cause-Specific Analysis

Abstract

Six Demographic and Health Survey (DHS) Phase I surveys were selected that had used the questionnaire for high contraceptive prevalence countries (Morocco Tunisia Egypt Ecuador Indonesia and Thailand). Typically about one-third of the couples stopped using their contraceptive method within 1 year of acceptance and about half did so within 2 years. In all six countries users of IUDs were more likely than users of other methods to be continuing both at 12 months and at 24 months after acceptance. 82-89% of IUD users persisted with use after 1 year and 65-80% continued use at the end of 2 years. For instance in Thailand only 23% of episodes of IUD use ended within 24 months compared with 50% of episodes of pill use. In Egypt the corresponding figures were 24% and 59% respectively. The three main reasons of discontinuation were: desire for a child method failure and health concerns (including side effects). For hormonal contraceptives and the IUD health concerns were the most common reason. For all methods combined about 10% of episodes were terminated within the first year for this reason and about 20% were ended within two years. Users of periodic abstinence withdrawal the condom herbs breast feeding and other traditional methods were unlikely to stop because of health concerns but such concerns were a major reason for giving up hormonal methods. In Tunisia Egypt and Ecuador about 20% of all hormonal method users stopped for this reason by the end of the first year and about 30% did so within two years. For withdrawal and periodic abstinence accidental pregnancy was the dominant reason. Probabilities of failure were high among users of periodic abstinence and withdrawal in every country except Indonesia. Women using the pill or the IUD were more likely to continue use if they had attained their desired family size. Education and residence had little effect on levels of pill discontinuation.