Discontinuation and switching of postpartum contraceptive methods over twelve months in Burkina Faso and the Democratic Republic of the Congo: a secondary analysis of the Yam Daabo trial

Abstract

Introduction Women who use contraceptive methods sometimes stop early, use methods intermittently, or switched contraceptive methods. All these events (discontinuations and switching) contribute to the occurrence of unwanted and close pregnancies. This study aimed to explore contraceptive discontinuation and switching during the Yam-Daabo project to measure the effect of interventions on the continuation of contraceptive methods use. Methods We conducted a secondary analysis of the Yam-Daabo trial data. We choose the discontinuation and switching of a modern contraceptive method as outcome measures. We performed a survival analysis using the Stata software package to estimate the effect of the interventions on contraceptive discontinuation. We also studied the main reasons for discontinuation and switching. Results In total, 637 out of the 1120 women used at least one contraceptive method (of any type), with 267 women in the control and 370 in the intervention group. One hundred seventy-nine women of the control group used modern methods compared to 279 women of the intervention group with 24 and 32 who discontinued, respectively. We observed no statistically significant association between interventions and modern methods discontinuation and switching. However, modern methods’ discontinuation was higher in pills and injectables users than implants and IUDs users. The pooled data comparison showed that, in reference to the women who had not switched while using a modern method, the likelihood of switching to a less or equal effectiveness method among the women of the control group was 3.8(95% CI: 1.8–8.0) times the likelihood of switching to a less or equal effectiveness method among the women of the intervention group. And this excess was statistically significant (p < 0.001). The main reason for discontinuation and switching was method-related (141 over 199), followed by partner opposition with 20 women. Conclusion The results of this study show no statistically significant association between interventions and modern methods discontinuation. Discontinuation is more related to the methods themselves than to any other factor. It is also essential to set up specific actions targeting women’s partners and influential people in the community to counter inhibiting beliefs. Trial registration Pan African Clinical Trials Registry (PACTR201609001784334, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1784).

Assessing Contraceptive Switching and Discontinuation Over 3 Years in the HER Salt Lake Study

“…Outside of larger contraceptive initiatives, it is common for studies to frequently stop assessing method change at 12 months. 5 – 8 Our findings suggest that for many methods, including oral contraceptives, individuals may be reassessing their contraceptive after 12 months. This finding warrants further investigation.…”

“…Because of methodologic challenges of examining time-varying behaviors, most prior studies have focused on exploring associations with single instances of method change or shorter durations of time. [5][6][7][8] Although these studies provide valuable insight into associated variables of method change, a fuller picture of what contraceptive change looks like over time is still elusive. Contraceptive counseling has traditionally prioritized methods by efficacy and duration of use, presuming that method use is relatively straightforward and decisions are long term.…”

Long-Acting Contraceptive Switching and Its Associated Factors among Married Women in Southwest Ethiopia

“…The challenge of contraceptive switching from more effective to less effective methods has become pronounced, particularly in developing countries like Ethiopia, contributing to high rates of unintended pregnancies ( Bekele et al, 2015 ). Studies have found that women who discontinue contraception often switch to less effective methods ( Abou Coulibaly et al, 2020 ). Predictors of method switching include women's age, educational status, income level, and parity ( Alia et al, 2014 ).…”

Reproductive outcomes following contraceptive discontinuation for method-related reasons: An analysis of 49 Demographic and Health Surveys

“…While many analyses of contraceptive switching have focused on switching to more effective methods [5,25], we chose to document any resumption of contraceptive use as an outcome. Nevertheless, these findings inform ongoing discussion on the definition of method "switching," since some sources define switching as occurring within one to three months of discontinuation; while other studies have examined longer time frames [10,11].…”