Global Contraceptive Failure Rates: Who Is Most at Risk?

Abstract

Contraceptive failure is a major contributor to unintended pregnancy worldwide. DHS retrospective calendars, which are the most widely used data source for estimating contraceptive failure in low‐income countries, vary in quality across countries and surveys. We identified surveys with the most reliable calendar data and analyzed 105,322 episodes of contraceptive use from 15 DHSs conducted between 1992 and 2014. We estimate contraceptive method‐specific 12‐month failure rates. We also examined how failure rates vary by age, education, socioeconomic status, contraceptive intention, residence, and marital status using multilevel piecewise exponential hazard models. Our failure rate estimates are significantly lower than results from the United States and slightly higher than previous studies that included more DHS surveys, including some with lower‐quality data. We estimate age‐specific global contraceptive failure rates and find strong, consistent age patterns with the youngest users experiencing failure rates up to ten times higher than older women for certain methods. Failure also varies by socioeconomic status, with the poorest, and youngest, women at highest risk of experiencing unintended pregnancy due to failure.

Adding It Up: Investing in Sexual and Reproductive Health 2019

“…31 Estimates of maternal deaths and their causes are from the UN Maternal Mortality Estimation Inter-Agency Group 32 and the Institute for Health Metrics and Evaluation, respectively, 33 and data for newborns are from WHO. 34 Estimates of the number of unintended pregnancies averted as a result of contraceptive use are based on age-and method-specific usefailure rates from a number of studies [35][36][37][38] and a pregnancy rate for women who want to avoid a pregnancy but are using no method. 39 We applied country-specific adjustment ratios to our estimates of unintended pregnancies to align them with a robust set of modeled estimates.…”

Level and timing of Implanon discontinuation and associated factors among women who used Implanon in Andabet District, public health facilities, North-West Ethiopia, 2017

“…Discontinuation while still in need (DWSIN) is particularly problematic when it leaves women at risk of an unwanted pregnancy, which was true for 15 to 20 percent of LARC users three months after discontinuation (11). The incidence of unintended pregnancy secondary to improper switching of another method after discontinuation was high among low-socioeconomic women in developing countries (16)(17)(18). Although, there is a high number of women come to health institution and requesting removal of Implanon prematurely and its contribution to increasing unwanted pregnancy is high, there is little study and had limited information available from developing countries including Ethiopia.…”

The complex relationship between contraception and abortion

“…contraceptives, condoms, periodic abstinence and withdrawal (table 1). Using information from 15 DHSs with high quality data, it was estimated that 19% of periodic abstinence users, 17% of withdrawal users, 9% of condom users and 6% of pill users will become pregnant by month 12 of use [19]. Table 1 also shows the average percentage of women still using specified methods 12 months after starting, estimated from DHSs [20,21].…”