Factors affecting contraceptive continuation and switching

Side effects or fear of side effects have been shown to be an important factor in the lack of adoption of contraceptive methods, particularly modern hormonal methods, however little is known about the actual experience of side effects and their influence on contraceptive use dynamics. This study aims to explore the association between the experience of side effects, the type of method, and the duration of episodes of use. This paper uses calendar data from a longitudinal survey conducted in Southern Ghana containing monthly reporting
of contraceptive use along with concurrent reporting of side effects. Descriptive statistics and single decrement life tables are used for the analysis. The result show that injectable use is most commonly associated with side effects, with 33.8% of episodes of contraceptive use being associated with the experience of side effects compared to 28.3% of pill episodes. However due to the longer length of episodes when taking into account all months of use only 9% of women-months of injection use have side effects compared to 11% of women-months of pill use. The length of pill episodes is not affected by side effects whereas for injectables the length of episodes is shorter when side effects are experienced than when they are not.

In Pakistan the contraceptive prevalence rate is stagnant at 30% for almost a decade along with high unmet need for contraception (25%) and unwanted fertility as one child per woman (PDHS, 2008). The family planning program of Pakistan has long been focusing on small family size. Recently the focus of this program has been shifted to the spacing between births. It is therefore important to study the behavior of couples regarding contraception following childbirth. Using the contraceptive calendar data from the FALAH baseline survey 2008-09 from the 29 districts across Pakistan, we study the duration of uptake of contraception after childbirth by using life table techniques. We also study the type of contraceptive method adopted and the differentials in the uptake. The effect of desire for more children, antenatal care visits and the place of delivery on the subsequent contraceptive uptake was analyzed using Cox Proportional Hazard Regression Models. Results show that less than a quarter of women adopted an FP method within 6-months of childbirth and desire to limit childbearing was significantly associated with higher uptake. The findings of this study will highlight the importance of introducing the postpartum family planning use in the FP program of Pakistan.

Women in Malawi bear on average six children, with many unintended pregnancies. Although 42% of married women use modern methods of contraception, 26% have an unmet need. The Karonga Prevention Study operates a demographic surveillance site (DSS) in northern Malawi.

An innovative method was devised for collecting family planning (FP) data using patient-held records (a “FP card”) to build a prospective longitudinal dataset, allowing exploration of continuity of use and method-switching, which can be linked to the DSS database. All 8,176 women aged 15-49 living in the DSS were offered a FP card. When a woman received FP, the health provider recorded on the FP card the date, method/service received and provider-type. After one year, the FP cards were collected for analysis.

Analysis is at an early stage but preliminary findings show that 6% of FP users used more than one method of FP during the study year (excluding condoms). Survival analysis revealed that just over a quarter of women who used injectables at the start of the study were still adhering to injections at the end of the study year. There appears to be no association between fertility intentions and discontinuation.

FP data usually come from surveys or routine data. This alternative method enables better understanding of how women maintain continuity of use.

The study is an attempt to understand the contraceptive use pattern and method’s choice among currently married women in India. The present study has been utilized DLSH-3 data which is a nation wide survey and collected information from 643944 ever married women aged 15-49 years regarding family planning, contraception, HIV/RTI and other socio-demographic aspects. Bi-variate and Multivariate analysis have been used for this study. Result shows contraception use increases with women’s age. Prevalence of contraceptive usages is higher among Hindu religion, women having no sex preference of child and women belonging in richest wealth quintiles. Women age is found significant determinant of contraceptive methods choice. Condom use is highest in the youngest age. Female sterilization is higher among poor women where as condom use is higher among richest women. Rural women are 17 percent lees likely and working women are two times more likely to choice condom over sterilization.