Determinants of contraceptive failure switching and discontinuation: an analysis of DHS contraceptive histories.

Abstract

This study examines the determinants of contraceptive discontinuation in Bangladesh Colombia Egypt Indonesia Peru and Zimbabwe including failure switching abandonment of use while not in need and abandonment of use while in need. Data were obtained from monthly contraceptive histories in Demographic and Health Surveys. Analysis is based on life table techniques and multivariate hazard models. Findings indicate that discontinuation is common. Almost 50% of users discontinued within 2 years of starting in Egypt Indonesia and Zimbabwe. About 66% discontinued in Bangladesh Colombia and Peru. A major reason for method switching and abandonment was the reduced need for contraception. 2-year contraceptive failure rates ranged from 7.6% in Indonesia to 29.4% in Peru. 2-year rates of abandonment while still in need ranged from 11.5% in Indonesia to 26.8% in Bangladesh. The choice of method was strongly associated with the likelihood of each of the 4 types of discontinuation. Modern method users had lower failure rates but a greater likelihood of discontinuation while still in need. Condoms were associated with high rates of switching at early durations as were injectables. The likelihood of abandonment due to reduced need was higher for condoms than for other methods. There was a lower likelihood among IUD users of contraceptive failure switching and abandonment due to reduced need. The likelihood of abandonment while still in need was lower for the IUD than for other modern methods and higher than for traditional methods. Socioeconomic variables were unrelated to discontinuation. The strongest determinants of discontinuation were fertility intentions number of living children and marital status. Socioeconomic variables were related to switching and abandonment while in need. Community level variables had inconsistent effects and considerable cluster level influences.