Does Contraceptive Discontinuation Matter?: Quality of Care and Fertility Consequences
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Contraceptive discontinuation is often cited as an outcome associated with the quality of care provided by family planning programs. This study documented levels of discontinuation across countries and assessed the utility of using these indicators as a reflection of the quality of the service environment. Additionally, this study examined contraceptive behavior following a discontinuation and the fertility consequences of contraceptive discontinuation and failure. Study authors collected contraceptive histories in 15 DHS surveys to calcuate a range of life table measures of discontinuation. The study found the following key findings: 1) Hormonal methods are more likely than other methods to be discontinued as a result of side effects or health concerns. 2) For most countries, women were most likely to switch to another contraceptive method after discontinuing the use of one method. Few women return to a method they have discontinued. 3) Overall, between 9% and 34% of women stop using contraception within one year for quality-related reasons. 4) Contraceptive failure and discontinuation make a substantial contribution to overall fertility rates and to rates of unwanted fertility. The total fertility rate for the 15 countries sampled would have been, on average, 14 percent lower in the absence of contraceptive failure. This report recommends that as fertility declines, family planning programs shift from providing methods to new clients towards providing more services to existing clients that help reduce failure and discontinuation rates.