Contraceptive discontinuation in urban Honduras

Janine Barden-O’Fallon, PhDIlene Speizer, PhD

University of North Carolina at Chapel Hill, USA

29 September 2009

Overview

Results from a one-year follow-up study with reversible method users conducted in Honduras, 2006-2007

The study was funded by USAID and implemented by MEASURE Evaluation in collaboration with Programas para el Desarollo de Infantes y Mujeres (PRODIM)

Contraceptive Discontinuation

Common, though varies by country

Most common during first 12 months of use

Contributes to unmet need

Can lead to unplanned pregnancy and unwanted births, resulting in negative public health outcomes

Objective

To determine how multiple factors affect contraceptive discontinuation among users of temporary methods over a one-year period Demographic characteristics

Fertility motivations

Partner engagement

Quality of FP services

Experience of side effects

Method characteristics

Study Sites

Data: Panel study collected in 2 rounds

Baseline exit interviews with 800 women aged 15-44, attending a FP appointment in selected health facilities in which they received the injectable, IUD, or oral contraceptive pill Women were both new and continuing users

There were no quotas by type of method

Follow-up interviews completed with 671 (84%) 1 year later

Study sample at baseline (n=671)

Young (94% under age 35)

Educated (30% reached secondary or higher)

Parity >/= 1

Married/in union (89%)

Urban residents (77%)

Desire to space a birth 2+ years (50%) or no more children (34%)

Method use by status of user at Baseline; N=671

Continuing (n=52%)

New Adopter (n=13%)

New Switcher (n=35%)

0

10

20

30

40

50

60

70

80

Injectable (72%)

IUD (21%)

Pill (7%)

Discontinuation Rate of Baseline Method, N= 324

Baseline Method

@ 6 months

@ 12 months

Injectable 0.25 0.50

IUD 0.16 0.31

Pills 0.22 0.44

TOTAL 0.23 0.45

Results: Discontinuation was common…

Transition to First Episode of Non-Use, N= 324

Baseline Method

@ 6 months

@ 12 months

Injectable 0.14 0.30

IUD 0.07 0.12

Pills 0.06 0.28

TOTAL 0.12 0.25

…But many switched to another method

Multivariate analysis: Cox proportional hazards models Model 1: Time until discontinuation of

baseline method

Model 2: Time until first episode of non-use of any method (Model 2)

Covariates: demographic characteristics, fertility motivations and family engagement, experience of side effects, baseline service quality, and user status at baseline

Stratified by baseline method

Demographic characteristics

Age 25+ Parity 0/1 Not in union at FU

Urban

0

0.5

1

1.5

2

2.5

1.34 1.35

1.97

2.27

0.74

Model 1

Model 2

**

*

**

***

***

Fertility motivations & family engagement

0

0.5

1

1.5

2

2.5

1.4

0.75

2.04

Model 1

Model 2

***

0.75*

*

**

Experience with side effects

Heavy bleeding

Weight gain Dizziness Interfered with daily

life

0

0.5

1

1.5

2

2.5

2.07

1.85

1.561.79

1.94

Model 1

Model 2

***

Service quality

Felt provider

answered all ques-

tions0

0.5

1

1.5

2

2.5

0.76

Model 1

Model 2*

Discussion

More than 4 out of 10 women discontinued the baseline method

Living in rural areas may limit ability to successfully switch methods

Service quality had little effect on discontinuation

Family and friends may support continuation

MEASURE Evaluation is funded by the U.S. Agency for

International Development and is implemented by the

Carolina Population Center at the University of North

Carolina at Chapel Hill in partnership with Futures Group

International, ICF Macro, John Snow, Inc., Management

Sciences for Health, and Tulane University. The views

expressed in this presentation do not necessarily reflect

the views of USAID or the United States Government.

Thank you