Stop or Switch: Correlates of Stopping Use or Switching Contraceptive Methods While Wanting to Avoid Pregnancy in 48 Low‐ and Middle‐Income Countries

Abstract

Contraceptive discontinuation for method-related reasons, while presumably wanting to avoid pregnancy, is a common phenomenon and can contribute to high levels of unmet need and unplanned pregnancies. Some women discontinue contraceptive use and do not quickly resume a method ("stopping"), while others are able to quickly switch to another method to achieve their reproductive goal of avoiding pregnancy ("switching"). We use Demographic and Health Survey data from  countries to examine what differentiates women who were able to switch to another method versus those who ultimately stopped entirely, among women who discontinued contraception for method-related reasons. Results show that wanting to limit births, having ever been married, and recent prior use are all associated with switching versus stopping. In addition, we find that women in West and Middle Africa were more likely to stop use compared to women in other regions. Addressing obstacles to contraceptive continuation, including effective method switching, among women who wish to delay or avoid pregnancy should be a priority for global and country initiatives aiming to deliver client-centered care that supports women and couples to make their best family planning choices.

Reproductive outcomes following contraceptive discontinuation for method-related reasons: An analysis of 49 Demographic and Health Surveys

“…The present study highlights how global family planning metrics that focus on discontinuation rates alone, such Indicator 18a in the FP2020 Core Indicators [32], provide an incomplete picture of women's contraceptive behaviors and may inform misguided strategies to enhance family planning efforts. While a substantial number of women may be at risk of unintended pregnancy following discontinuation, our results showed that that the majority of women in some countries and regions were able to resume contraception in a timely manner to avoid this outcome, corroborating several recent studies [33,34]. We recommend the development of more nuanced measures of contraceptive use dynamics that distinguish women who resume use of contraception from those who remain at risk of pregnancy in the short period following discontinuation in order to better inform specific polices and interventions, particularly aimed at the latter group.…”

Assessing Contraceptive Switching and Discontinuation Over 3 Years in the HER Salt Lake Study

“…1 Despite several new studies assessing method change over time, important gaps still exist in the literature. [2][3][4] Determining how decision making about contraception changes over time is challenging. Because of methodologic challenges of examining time-varying behaviors, most prior studies have focused on exploring associations with single instances of method change or shorter durations of time.…”

“…1 Despite several new studies assessing method change over time, important gaps still exist in the literature. 2–4…”

The Relationship Between Contraceptive Method Use and Return of Fecundity Among Women Attempting Pregnancy in Low- and Middle-Income Countries

“…Following prior multicountry DHS studies ( Bradley and Shiras 2022 ; Gemmill et al 2018 ; Sarnak et al 2023 ), we used custom weights accounting for complex sampling designs to allow each country to contribute equally to the pooled analysis; this approach ensures that results are not weighted more heavily toward surveys with larger sample sizes. Specifically, we multiplied the DHS-provided survey weights by a country-specific constant, such that the sample of women from each of the 47 countries in our analysis makes up 1/47th of the pooled sample, the derivation of which is outlined in detail elsewhere ( Bradley and Shiras 2022 ).…”