Factors Associated With 12-Month Discontinuation Among Contraceptive Pill, Patch, and Ring Users

Abstract

OBJECTIVE: To examine factors associated with discontinuation of the oral contraceptive pill (OCP), patch, and ring. METHODS: We included 1,452 female participants from the Contraceptive CHOICE Project who selected the OCP, patch, or ring and completed 12 months of follow-up for this analysis. We defined discontinuation as stopping the contraceptive method for longer than 1 month during a follow-up survey. Participants who stopped their method as a result of pregnancy or to attempt pregnancy or who were lost to follow-up were censored. We examined demographic, behavioral, and method-related factors in the Cox proportional hazard models. RESULTS: Patch users had a higher 1-year discontinuation rate (58%) than OCP (47%; P=.03) and ring users (49%; P=.02). Women were more likely to discontinue the OCP, patch, or ring if they were black (adjusted hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.02-1.44), no longer married (adjusted HR 1.83, 95% CI 1.27-2.65), or received public assistance (adjusted HR 1.30, 95% CI 1.08-1.57). Women who reported difficulty obtaining the method were more than twice as likely to discontinue (adjusted HR 2.43, 95% CI 1.81-3.27). Women who were certain they would continue despite side effects (adjusted HR 0.57, 95% CI 0.43-0.77) were less likely to discontinue. CONCLUSION: Despite selecting their method and obtaining it at no cost, almost half of OCP and ring users and a majority of patch users discontinued their method by 12 months. Experiencing difficulty obtaining the method contributes to high rates of discontinuation. LEVEL OF EVIDENCE: II.