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

Abstract

One of the most common barriers to using effective family planning methods is the belief that hormonal contraceptives and contraceptive devices have adverse effects on future fertility. Recent evidence from high-income settings suggests that some hormonal contraceptive methods are associated with delays in return of fecundity, yet it is unclear if these findings generalize to low- and middle-income populations, especially in regions where the injectable is widely used and pressure to bear children is significant. Using reproductive calendar data pooled across 47 Demographic and Health Surveys, we find that the unadjusted 12-month probability of pregnancy for women attempting pregnancy after discontinuing traditional methods, condoms, the pill, and the IUD ranged from 86% to 91%. The 12-month probability was lowest among those who discontinued injectables and implants, with approximately 1 out of 5 women not becoming pregnant within one year after discontinuation. Results from multivariable analysis showed that compared with users of either periodic abstinence or withdrawal, users of the pill, IUD, injectable, and implant had lower fecundability following discontinuation, with the largest reductions occurring among women who used injectables and implants. These findings indicate that women's concerns about potential short-term reductions in fecundity following contraceptive use are not unfounded.

Reproductive autonomy and the experience of later-than-desired pregnancy: results from a cross-sectional survey of reproductive-aged women in Uganda

“…Our results and associations conflate these two groups, which may in fact be distinct. Among those experiencing a biological impairment, the delay could be related to recent hormonal contraceptive use as some hormonal methods are shown to be associated with delayed return to fecundity [ 61 , 62 ], however, we did not have the necessary data to explore this potential explanation. Additionally, we do not know specifically when the women in our study preferred to have a child as we only asked how long they had been trying, which may be inadequate to assess the extent of mistiming for those not experiencing a biological impairment.…”