Contraceptive Discontinuation
The 300 million users of family planning in FP2020 countries are not a static group.
For various reasons, women and their partners may stop using a modern contraceptive method or may switch to a different method. Contraceptive discontinuation presents a challenge to achieving FP2020 goals, as data indicate that many women begin using contraceptives and then discontinue, putting themselves at risk of an unintended pregnancy. Analysis of DHS data available since 2012 from 21 countries shows that discontinuation rates are particularly high for short-term methods, including pills and injectables. Together the discontinuation rates for method-related reasons and other non-fertility related reasons suggest that more than 20% of users of each of these methods stopped use within 12 months.
Although reasons for discontinuation vary, the most common reasons, other than fertility-related reasons (such as stopping use to get pregnant), are method-related. These include side effects/health reasons, method failure, and the desire for a more effective method. Some users discontinue use of one contraceptive method and switch to a different method. Method switching, which is most common for users of short-term methods, can occur for various reasons, such as a stock-out of the user’s preferred method at a service delivery point. Not all method-switching is negative; a woman may decide to stop using a particular method in favor of one she prefers, or may switch from a less effective short-term method to a more effective long-term method that offers better protection from unintended pregnancy.
Other reasons for discontinuation may relate to the service environment in which contraceptives are provided: factors such as service quality, availability of methods, and referral mechanisms. Interventions are underway in FP2020 countries to address method and service-related reasons for contraceptive discontinuation, but measurement remains a challenge. Most of the currently available data on discontinuation comes from retrospective surveys and contraceptive calendars, which are not applicable to tracking client-specific method use over time. This information can be collected through health management information systems that track individual users longitudinally, as has been demonstrated by some private sector providers. Such systems hold promise for more effective monitoring and evaluation, but they have not been mainstreamed into public sector family planning programs.
Additional investments in data collection and monitoring and evaluation can yield better information about the dynamics of contraceptive use—information that can be used to develop and improve programmatic interventions aimed at reducing discontinuation. Achieving FP2020’s ambitious goal and ultimately fulfilling the SDGs will require expanding access to family planning, but it also means ensuring that current users continue to have their contraceptive needs met. Addressing contraceptive discontinuation is critical to meeting these needs.
A Closer Look: Contraceptive Discontinuation
This section of the report draws from a December 2015 report released by FP2020 and Population Council titled "Contraceptive Discontinuation: Reasons, Challenges, and Solutions.” "Contraceptive Discontinuation: Reasons, Challenges, and Solutions.” The report provides an in-depth look at reasons for discontinuation, interventions to reduce discontinuation and/or enhance switching to new methods, and measurement and monitoring of discontinuation. It presents evidence from a review of literature spanning 25 years, proposes a theory of change for addressing discontinuation, and outlines a research agenda to enhance understanding of the phenomenon.
