What characteristics differentiate method switchers

from discontinuers?

Janine Barden-O’Fallon, PhDIlene Speizer, PhD

University of North Carolina at Chapel Hill, USA9 November 2010

Presenter Disclosure

Janine Barden-O’Fallon

(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

No relationships to disclose

Overview

Findings from a one-year follow-up study with reversible method users conducted in Honduras, 2006-2007

The study was funded by USAID and implemented by MEASURE Evaluation in collaboration with Programas para el Desarollo de Infantes y Mujeres (PRODIM)

Contraceptive Discontinuation

Common, though varies by country

Most common during first 12 months of use

7-20% due to “reduced need”

Contributes to unmet need

Can lead to unplanned pregnancy and unwanted births, resulting in negative public health outcomes

Objective

To examine differences between women who reinitiate contraceptive use immediately after a discontinuation (i.e. switch methods) and women who discontinue use and do not immediately begin another method (i.e. experience an episode of non-use).

Factors included in analysis:

-Demographic characteristics -Communication

-Fertility desires -Method characteristics

-Service quality -Reason for discontinuation

-Experience of side effects

Study Sites

Baseline exit interviews with 800 women aged 15-44, attending a FP appointment in selected health facilities in which they received the injectable, IUD, or oral contraceptive pill Women were both new and continuing users

There were no quotas by type of method

Follow-up interviews completed with 671 (84%) 1 year later

Data: Panel study collected in 2 rounds

Study sample (n=671)

Compared to women who did not discontinue their baseline method (n=398), women who discontinued (n=273) were…

At a lower parity (47.6% vs. 41.7% with 0/1 child)

Not married at follow-up (15.7% vs. 7.3%)

Living in rural area (25.3% vs. 20.8%)

New to their method (53.1% vs. 45.0%)

Using the injectable (77.7% vs. 68.8%)

Significant factors related to women’s contraceptive status after discontinuation of baseline method (n=273)

CharacteristicSwitchers

(n=117)Discontinuers

(n=156)

Service at Baseline

Had all questions answered by provider 72.7 50.0

Side Effects

Had side effects during the study 89.7 69.9

Felt side effects interfered with daily activity 54.7 35.3

Sought help from clinic/health worker 55.6 28.2

Communication with others

Discussed side effects with 2 or more people 57.3 32.1

Discussed stopping BL method with partner before making decision to discontinue

86.3 60.3

Significant factors related to women’s contraceptive use after discontinuation among women experiencing the same side effectSide effect experienced Switchers Discontinuers

Amenorrhea (N=66) (n=22) (n=44)

Self-medicated/took home remedies 13.6 34.1

Sought help from a clinic/health worker 63.6 36.4

Discussed SE with 2 or more people 95.5 79.6

Heavy bleeding (N=64) (n=36) (n=28)

Discussed SE with 2 or more people 100.0 85.7

Discussed side effect with partner 80.6 46.4

Discussed stopping with partner 97.2 67.9

Headaches (N=82) (n=36) (n=46)

Self-medicated/took home remedies 36.1 56.5

Discussed stopping with partner 88.9 69.6

Multivariate logistic regression

Dependent variable: switch vs. episode of non-use

Independent variables: from bivariate analysis

Women not experiencing side effects are included in null categories

Correlated variables not included in model: experience of side effects during study period; discussion of side effects with 2 or more people; discussion of side effects with partner; and discussion of side effects with a health worker.

Odds Ratios for demographic, side effects, and communication variables significantly related to the likelihood of switching methods; Honduras, 2006-7, N=270

**p<0.05 +new/recent method adopters**, +discontinuation due to method problems**

Limitations

Right and left censoring of the data; analytical censoring

Focus on switching behavior rather than duration of use

Conclusions

There are significant differences between women who switch methods and women who discontinue, beyond the main reason for discontinuation

Urban residence

Treatment seeking for side effects

Discussing discontinuation with partner

MEASURE Evaluation PRH is a MEASURE project funded by

the United States Agency for International Development

(USAID) through Cooperative Agreement GHA-A-00-08-00003-

00 and is implemented by the Carolina Population Center at

the University of North Carolina at Chapel Hill in partnership

with Futures Group International, Management Sciences for

Health, and Tulane University. Views expressed in this

presentation do not necessarily reflect the views of USAID or

the U.S. Government. MEASURE Evaluation PRH supports

improvements in monitoring and evaluation in population,

health and nutrition worldwide.