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%)

01020304050607080

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 0.44TOTAL 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 0.28TOTAL 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

1.851.56

1.791.94

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 theCarolina Population Center at the University of North Carolina at Chapel Hill in partnership with Futures GroupInternational, ICF Macro, John Snow, Inc., Management Sciences for Health, and Tulane University. The views expressed in this presentation do not necessarily reflectthe views of USAID or the United States Government.

Thank you