Determinants of Method Switching among Social Franchise Clients Who Discontinued the Use of Intrauterine Contraceptive Device

Abstract

Introduction. Women who do not switch to alternate methods after contraceptive discontinuation, for reasons other than the desire to get pregnant or not needing it, are at obvious risk for unplanned pregnancies or unwanted births. This paper examines the factors that influence women to switch from Intrauterine Contraceptive Device (IUCD) to other methods instead of terminating contraceptive usage altogether. Methods. The data used for this study comes from a larger cross-sectional survey conducted in nine (9) randomly selected districts of Sindh and Punjab provinces of Pakistan, during January 2011. Using Stata 11.2, we analyzed data on 333 women, who reported the removal of IUCDs due to reasons other than the desire to get pregnant. Results. We found that 39.9% of the women do not switch to another method of contraception within one month after IUCD discontinuation. Use of contraception before IUCD insertion increases the odds for method switching by 2.26 times after removal. Similarly, postremoval follow-up by community health worker doubles (OR = 2.0) the chances of method switching. Compared with women who received free IUCD service (via voucher scheme), the method switching is 2.01 times higher among women who had paid for IUCD insertion. Conclusion. To increase the likelihood of method switching among IUCD discontinuers this study emphasizes the need for postremoval client counseling, follow-up by healthcare provider, improved choices to a wider range of contraceptives for poor clients, and user satisfaction.

Provision of family planning vouchers and early initiation of postpartum contraceptive use among women living with HIV in southwestern Uganda: A randomized controlled trial

“…Other scholars, however, have noted Family planning voucher and early initiation of postpartum contraceptive use that up to a third of women starting a modern contraceptive method discontinue the method within the first year [38]. Another trial (N = 1,163) specifically comparing continuation rates and reasons for discontinuation of an intrauterine device in Pakistan showed no difference in discontinuation between the voucher and nonvoucher groups at 24 months [39,40]. However, just like our study, the probability of continuation of an initiated contraceptive method was higher for the voucher cohort versus the nonvoucher cohort at 6 months.…”

Factors Determining Quality of Care in Family Planning Services in Africa: A Systematic Review of Mixed Evidence

“…To address this challenge, client satisfaction, a simple and more practical outcome measure, can serve as a good indicator and outcome measure in resource limited countries [35]. Client satisfaction has been found as a key determinant of uptake and continued use of family planning services [12,36]. Measuring client satisfaction not only evaluates certain aspects of quality of care but also indicates better prospects for sustainability in terms of recruiting new users and maintaining those clients who are already in the service [12,36,37].…”

“…Client satisfaction has been found as a key determinant of uptake and continued use of family planning services [12,36]. Measuring client satisfaction not only evaluates certain aspects of quality of care but also indicates better prospects for sustainability in terms of recruiting new users and maintaining those clients who are already in the service [12,36,37]. Evidence has also showed that good quality of healthcare positively correlates with patient satisfaction [38].…”

Method Shifting from Long to Short Term Contraceptives and its Associated Factors among Reproductive Age Women, Northwest Ethiopia, 2018

“…In addition, short term contraceptive methods have an increased discontinuation rate as compared to LACM. Moreover, the rate of unplanned pregnancy and abortion is high among short term contraceptive users as compared to the LACM users due to high failure rate or miss use [5,6,8].…”

“…A study conducted among IUCD users in Pakistan showed that 33.3% of women shifted their method of choice to short term methods [8]. Another study done in Malawi showed that 58% of woman switched to more effective method, 24% switched to similarly effective methods and 18% switched to less effective methods [9].…”