Contraceptive discontinuation in Egypt as fertility returns to its 2000 level

Abstract

Purpose The similarity of family planning (FP) indicators from EDHS2014 to that of EDHS2000 is alarming for policymakers and researchers who consider it as an echo of the past and a threat, which the FP programme has to face to prevent its progression. In 2000, the total fertility rate (TFR) was 3.5, the contraceptive prevalence rate was 56.1% and the discontinuation rate was 29.5%. In 2014, these indicators were 3.5, 58.5 and 30.1%, respectively. Although the change in the all method discontinuation rate is not large, it is a result of great changes in the method specific discontinuation rates, which was masked by changes in the contraceptive method mix. This study aims to present a comparison between contraceptive discontinuation rates in 2000, 2008 and 2014, discuss the reasons for discontinuation by methods and background characteristics of women and calculate the impact of eliminating discontinuation for reasons related to method and service provision on fertility. Design/methodology/approach Single/multiple decrement life tables were applied to the calendar data of the EDHS2008 and EDHS2014, to examine various net rates of contraceptive discontinuation by reasons and the status after discontinuation. The TFR estimated in the absence of method failure and abandonment while in need of births occurred within 24 months after discontinuation using installed Stata command tfr2. Findings The study estimates the impact of discontinuation on the TFR in 2014 to be an increase of about 20%. The TFR of 3.5 would have been only 2.8 if discontinuation due to method failure and method/service-related reasons were eliminated. Improvement regarding discontinuation behaviour is evident by increased switching, from 43.6 to 54.3% and the drop in the proportion of abandoning use while in need from 56.4 to 45.7%. Differentials suggest that discontinuation is expected to increase among vulnerable groups as desired fertility continues to rise. The increase in the share of “desire to become pregnant” – as a reason for discontinuation is a recent trend observed during the period between EDHS2008 and EDHS2014 and is recognised as a challenge by the national population strategy. Originality/value This study confirms that contraceptive discontinuation is an important part of the overall fertility increase observed by EDHS2014. The rising trend of increased desired family size and the shift away from using the intra uterine device may be considered as major challenges facing the FP programme in Egypt.

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“…The results of the National Family Health (NFHS-3) Survey in the state of Meghalaya which is located in Northeastern part of India concluded a significant correlation between the ideal number of children and both of residence, religion, highest educational level, work status, standard of living index and the respondents' age (Khongji 2013). It has pointed to the woman's desire to have more children had significant impact to increase the TFR of Egypt during the period between EDHS2008 and EDHS2014, and it expects to increase among vulnerable groups, and thus to rise TFR as a reason for contraceptive discontinuation (Khalifa et al 2020). Another cross-sectional study aimed to determine the factors affecting the reproductive desires of the modern Bulgarian families which covered 243 couples were interviewed.…”

The impact of method choice on the risk of contraceptive discontinuation: Egypt 2014

“…However, fertility rose during the six-year period reported by the last two EDHS of 2008 and 2014, from its lowest level of 3.0 children per woman to 3.5 and the national goal of achieving a TFR of 2.1 by 2017 has not been achieved (National Population JHASS 4,1 Council, 2015). TFR would have been only 2.8 if discontinuation due to method failure and method/service-related reasons were eliminated (Khalifa et al, 2020b). This indicates that discontinuation due to method failure and method/service-related reasons contributed to an increase in fertility by almost 20% in Egypt 2014.…”