Oral contraceptive discontinuation and its aftermath in 19 developing countries

Background: The purpose of the article was to document oral contraceptive (OC) discontinuation and switching in a large number of low- and middle-income countries, and to assess the effects of women's education and reason for use (spacing vs. limitation). An attempt was made to explain intercountry variations. Study Design: Calendar data from 19 Demographic and Health Surveys conducted between 1999 and 2005 were used. Data were analyzed by single- and multiple-decrement life tables and by Cox proportional hazard model. Results: The probability of stopping OC use within 12 months for reasons that implied dissatisfaction with the method ranged from 15% in Indonesia to over 40% in Bolivia and Peru with a median value of 28%. On average, 35% switched to a modem method within 3 months and 16% to a less effective 'traditional' method. Both education and reason for use were strongly related to the probability of switching to a modem method. Discontinuation was lower and switching higher in countries judged to have strong family planning programs. Conclusions: Both discontinuation of use and inadequate switching to alternative methods are major but neglected problems in the family planning services of many developing countries. (C) 2010 Elsevier Inc. All rights reserved.