In six diverse developing countries, more than four in 10 women discontinue use of their method within one year, according to a study by Sian Curtis of the University of North Carolina, Chapel Hill, et al., published in the June issue of International Perspectives on Sexual and Reproductive Health. Data from 1999–2003 Demographic and Health Surveys from Bangladesh, the Dominican Republic, Kazakhstan, Kenya, the Philippines and Zimbabwe indicate that contraceptive discontinuation rates ranged from 20% in Zimbabwe to 48% in Bangladesh and the Dominican Republic. In every country, with the exception of Kazakhstan, the top three reasons for discontinuation were the desire to get pregnant, contraceptive failure and side effects.
To explore how fertility desires contribute to stopping contraceptive use, the researchers examined women’s attitudes toward pregnancies following discontinuation for reasons other than a desire to have a child. The proportion of births reported as intended following contraceptive failure ranged from 16% in Bangladesh to 54% in Kazakhstan, while the proportion of such births following discontinuation because of side effects ranged from 37% in Kenya to 51% in Kazakhstan.
Because relatively high proportions of births were reported as intended following contraceptive failure or discontinuation for reasons other than wanting to get pregnant (for example, side effects), Curtis et al. suggest that ambivalent fertility desires are an important factor in contraceptive discontinuation. In addition, older age, having fewer than five living children, and longer durations between contraceptive discontinuation and pregnancy were associated with reporting births as intended.
In all countries except Kazakhstan, 71–84% of women who became pregnant while using a contraceptive method and 56–63% of women who gave birth after discontinuing use because of side effects reported the birth as unintended. According to the researchers, increasing the proportion of couples adopting a contraceptive method who continue to use it successfully or switch to another method is a critical element in preventing unwanted births and reducing the need for induced abortions. Curtis et al. conclude that reducing unintended pregnancy will require identifying women who strongly want to avoid a pregnancy and finding ways to help them maintain contraceptive use.
The study, "Contraceptive Discontinuation and Unintended Pregnancy: An Imperfect Relationship," is available online and will appear in the June 2011 issue of International Perspectives on Sexual and Reproductive Health.