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Probability of contraceptive continuation and its determinants.

Probability of contraceptive continuation and factors associated with discontinuation were assessed in a retrospective study of women's records in Alexandria. Contraceptive continuation rates were 88/100, 75/100 and 56/100 women at 6, 12 and 24 months respectively. Reasons for discontinuation included side-effects and health concerns (30.4%), accidental pregnancy and personal reasons (6.4%) and desire for pregnancy (5.4%). Women who were older and who had several children were most likely to continue contraceptive use. Three significant predictors of discontinuation were side-effects and health concerns, age of the woman and contraceptive method. Women should be fully informed of the contraceptive methods available and their side-effects, and counselling programmes should be offered, particularly during the first 2 years of use.

Adult↗

Determinants of contraceptive continuation in rural Bangladesh.

A contraceptive study of rural Bangladeshi women indicated that the previous death of children, number of living children, desire for additional children and son preference were important determinants of contraceptive continuation. The importance of these factors varies to some extent with use of different contraceptive methods.

Adolescent↗

The postcoital IUD as an effective continuing contraceptive method.

A two-year controlled clinical study of the effectiveness of postcoital IUD as a continuing contraceptive method in 98 women requesting a postcoital contraception is presented. The control group was selected from women requesting an IUD as contraceptive choice. The rates of accidental pregnancy, expulsion and removal for medical reasons did not differ between the two groups. Removal for personal reasons was the only termination event that showed a significant difference at one year. Moreover, the removal for personal reasons of interceptive IUD users mainly occurred in the early months after insertion. Postcoital IUD has proved to be an effective continuing contraceptive method. Special attention and sympathetic counseling should be given to postcoital IUD users before insertion and during the three months following insertion.

Adolescent↗

A pilot program of contraceptive continuation in six school-based clinics.

PURPOSE: Few school-based health centers (SBHC) in the United States dispense contraceptives on-site and little is known about contraceptive continuation in these health centers. METHODS: An 11-month contraceptive continuation pilot project offering monthly reproductive health assessment and counseling to students enrolled in Baltimore school clinics was evaluated. One hundred-forty-three women voluntarily enrolled in the study over a seven month period. A monthly contraceptive calendar was developed to collect data on contraceptive use, pregnancy and STD risk, sexual behavior and parental support for contraceptive use. Physical assessment was provided as needed to assess the presence of STD's or pregnancy. Data were analyzed for the month prior to enrollment in the program and eleven months after entry into the program. RESULTS: Both contraceptive (OCP) use and abstinence increased over the course of the program. Condom use remained at approximately 30% with frequent use of OCP's and condoms, condoms or abstinence. Program drop-out was common. Thirteen students became pregnant while enrolled in the program and 35% of the students were diagnosed with one or more sexually transmitted diseases. Partner-switching was common, although two or more partners within any one month was rare. CONCLUSIONS: Monthly follow-up provided through SBHCs can improve contraceptive use although dropout rate and contraceptive failure remain high.

Adolescent↗

Never-pregnant adolescents and family planning programs: contraception, continuation, and pregnancy risk.

Four hundred urban Black teenagers enrolling in a family planning program before pregnancies occurred were followed for one year to assess factors influencing continuation of contraceptive use. Over half the follow-up respondents claimed to always use contraception. Program discontinuers were less likely to use contraception, but nearly half had no sex activity when contacted at follow-up. Sex frequency reported in the sample was low. Background factors of age, grade, and household were associated with contraceptive use and with pregnancy. Girls who had pregnancies were significantly more likely to live in a single-parent household, to have sex more frequently, and to have stated at enrollment that they wanted their first child before age 20. A majority of the sample, nearly all of whom obtained oral contraception, did not know at the one year follow-up how to use any alternative methods for preventing conception, hence many would again be at risk of pregnancy when sex activity resumed.

Adolescent↗

Contraceptive continuation among adolescents attending family planning clinics.

An attempt to find a reliable way to measure contraceptive continuation among teenagers was made in a study of 445 adolescents under age 18 who made an initial visit to one of nine federally funded family planning clinics in the Philadelphia area in 1980 and 1981. The participants were interviewed at their initial visit and at six and 15 months to collect information on background characteristics, pregnancy history and contraceptive use. A cross-check of the information on contraceptive use reported during the study showed that 38 percent of the respondents who reported that they had been continuous users during the 15 months supplied information at other points indicating that they had not always used contraceptives during that period. In an attempt to examine the effects of adolescent reporting errors on measures of contraceptive use, the investigators constructed three alternative measures of contraceptive continuation. The simplest measure assessed current use at 15 months. A second measure accepted only reports of continuous use at 15 months and ignored inconsistent data. The third measure corrected for inconsistent data. Applying these measures to the study population produced proportions of contraceptive continuation ranging from a low of 43 percent when the most stringent measure was used to a high of 82 percent for the current-use category. Whatever the measure used, much of the discontinuation appears to have occurred in the first three months after the initial visit to a family planning clinic.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Contraception continuation rates and reasons for discontinuation in Zahedan, Islamic Republic of Iran.

We evaluated contraception continuation rates and discontinuation reasons in Zahedan among 1741 women from 1998-2000. By Kaplan-Meier technique continuation rates were 92% for low dose combined hormonal oral contraceptives (OC), 86% for a levonorgestrel-releasing implant, 82% for intrauterine devices (IUD) and 53% for medroxyprogesterone acetate at the first year. After 3 years, continuation was 78% for levonorgestrel implant, 70% for OC, 60% for IUD and 44% for medroxyprogesterone acetate. The commonest reason for discontinuing OC and medroxyprogesterone acetate was changing method; for IUD and levonorgestrel-releasing implant, the commonest reason was side-effects. By Cox regression model, continuation rate and contraceptive type were significantly related to health centre.

Adult↗

Contraceptive continuation rates in Papua New Guinea.

Family planning records were analyzed for 18 urban and rural clinics throughout Papua New Guinea. From the record cards of 7443 women, contraceptive continuation rates for the first method used were calculated. Continuation rates after one year are 92 per cent with the IUD (intra-uterine device), 41 per cent with oral contraceptives and 54 per cent with injections. Differences associated with age, parity, and rural-versus-urban clinics are discussed. Continuation rates are used to give an estimate of current contraceptive use of less than seven per cent of Papua New Guinea women. Improvement in access to services for rural women is needed, as is better communication in the initial interview with a new acceptor.

Adolescent↗

Contraceptive continuation and its determinants in Benin.

To understand better the rates of continuation of different contraceptive methods, a study in 12 family planning centers in Cotonou and Porto Novo, the two largest cities in Benin, was conducted. From January 1 to December 31, 1993, 944 questionnaires completed by new women acceptors of one of three methods of contraception (oral contraceptive, injection, or IUD) were analyzed. For all methods of contraception, the average length of follow-up was 9.5 months. From the start of the analysis, 44.4% (n = 419) of the women were regularly followed, 49.5% (n = 467) were not regularly followed, and 6.1% (n = 58) reported discontinuation of the method. One year after beginning the use of contraception, the cumulative proportion of women at risk of becoming pregnant, for all the methods together, was 42.0% (38.6-45.4%). Age was associated with the probability of abandoning oral contraception (p = 0.01). Three months after the start, the cumulative proportion of drop-out women having chosen oral contraceptive was 37.2% (22.8-51.6%) of the less than 20-year-olds, 19.0% (14.3-23.7%) of the 20- to 30-year-olds, and 23.4% (15.6-31.2%) of the over 30-year-olds. In contrast, drop-out was not associated with age for women using injection (p = 0.96) or the IUD (p = 0.47). Our results indicate a relatively high and rapid rate of discontinuation for modern contraceptive methods, particularly for young women having chosen oral contraceptive. This finding should incite the family planning educators to give more emphasis to the counseling programs, especially during the first three months.

Adolescent↗

Monitoring contraceptive continuation: links to fertility outcomes and quality of care.

This study examines the fertility consequences of contraceptive discontinuation, describes cross-national variation in continuation rates, and assesses the usefulness of the contraceptive discontinuation rate as a summary outcome indicator of quality of care. In the 15 countries included in this analysis, the total fertility rate would be between 28 and 64 percent lower if the births following discontinuations that were not the result of a desire to become pregnant had not occurred. The all-method discontinuation rate for quality-related reasons emerges as the most likely candidate for a summary measure of quality of care. Within a year of starting use of a method, between 7 and 27 percent of women cease to practice contraception for reasons related to the quality of the service environment. The results imply that as fertility declines, family planning programs would profit from a shift in emphasis from providing methods to new clients toward providing services to reduce discontinuation rates.

Adolescent↗

Oral contraceptive continuation rates in the Singapore National Program. 1966-1972.

A study of a random sample of 3,564 oral contraceptive acceptors in the Singapore national program clinics with a maximum of 60 months of experience produced findings as follows: The typical pill acceptor was aged 26.9 years with 2.5 children, married for 4.2 years, had at least primary education, was not working, and started on the pill 2.3 months after her last pregnancy. Thirty-three percent of the oral contraceptive acceptors were still continuing with the pill by the cutoff date for the study, 30 June 1972, and the median period of pill use among those still using was 33.6 cycles. The median number of cycles of pill use among discontinued users was only 5.2. The main reasons for discontinuation were side effects of the pill and planned pregnancy. For the discontinued users, 43 percent had used alternative methods of protection, mainly condoms. Cumulative continuation rates per thousand women were 792 after the first cycle, 680 after the third, and 475, 346, 247, and 225 after cycles 12, 24, 48, and 59, respectively.

Adult↗