In the most comprehensive study to date of contraceptive failure rates in the developing world, researchers found that overall, failure rates are lowest for users of longer-acting contraceptive methods (IUDs, implants or injectables), intermediate for users of shorter-acting methods (oral contraceptive pills or male condoms) and highest for users of traditional methods (withdrawal or calendar rhythm). The report, "Contraceptive Failure Rates in the Developing World: An Analysis of Demographic and Health Survey Data in 43 Countries" by Chelsea Polis of the Guttmacher Institute and colleagues, expands on previous research on failure rates by contraceptive method.
Using Demographic and Health Surveys from 43 countries, the researchers estimated failure rates among sexually active women of reproductive age for seven contraceptive methods over 12-, 24- and 36-month intervals. The data cover 17 countries in Africa, 16 in Asia, two in Eastern Europe and eight in Latin America and the Caribbean.
"Of the 74 million unintended pregnancies each year in the developing world, a significant proportion—30%—are due to contraceptive failure among women using traditional or modern methods," said Chelsea Polis, senior research scientist at the Guttmacher Institute and the study’s lead author. "Our findings on contraceptive failure rates can inform strategies to improve the provision of contraceptive services, focusing efforts where they are most needed, and helping women and couples to correctly and consistently use the methods best suited to their needs."
In addition to estimating method-specific failure rates, the researchers estimated the contraceptive prevalence and the method mix for each country and the seven subregions in the analysis, information that is critical in determining the type of policies and programs needed to reduce contraceptive failure rates. For instance, they found that while the Northern Africa/Western Asia subregion has relatively high contraceptive prevalence, a significant proportion of users rely on less effective traditional methods. By contrast, in Western Africa, contraceptive prevalence is relatively low, but the majority of users rely on modern methods.
In considering contraceptive failure rates among various demographic and socioeconomic populations, the authors found that women younger than 25 generally have higher contraceptive failure rates than their older counterparts. This finding holds true for all contraceptive methods except the implant, for which the failure rate did not vary by age. Moreover, the authors suggest that family planning programs and providers need to expand the availability of youth-friendly counseling and services to ensure that young women can successfully use their chosen contraceptive method.
The researchers propose that efforts to improve correct and consistent use of contraceptives among current users should go hand-in-hand with programs to inform nonusers interested in using modern contraceptives and assist them in adopting a method that works in their personal circumstances. They recommend that service providers make available a wide range of contraceptive methods so that women and couples can choose the most effective method with which they will be satisfied, and also emphasize that services must include comprehensive counseling and clear information about the risks and benefits, including possible side effects, of each method. The study’s authors hope the findings will inform family planning programs and services across the developing world and help focus attention on geographic subregions and subgroups of women that experience particularly high failure rates.
The full report is available online: "Contraceptive Failure Rates in the Developing World: An Analysis of Demographic and Health Survey Data in 43 Countries." A summary of the findings, "Contraceptive failure rates in 43 countries with Demographic and Health Survey data: summary of a detailed report," is currently available online and will be published in the forthcoming issue of Contraception.
This study was funded by UK aid from the UK government; however, the views expressed do not necessarily reflect the UK government’s official policies.