Not All Women Who Experience Side Effects Discontinue Their Contraceptive Method: Insights from a Longitudinal Study in India

Abstract

Side effects are a primary reason why women stop using contraception, even though they may still want to avoid a pregnancy. The Demographic and Health Surveys (DHS), the largest source of nationally representative data on contraceptive discontinuation, only asks women who discontinued a method their reasons for discontinuation, for which side effects is an option. Yet, side effects are also experienced by continued users. Using longitudinal data collected from a cohort of contraceptive users in Odisha and Haryana, India, this study explores the effect of side effect severity and frequency on six-month discontinuation. Among women who experienced side effects of their enrollment method, . percent continued to use it by the six-month interview. Women who experienced moderate/severe side effects infrequently were  percent (adjusted odds ratio [AOR]: .;  percent confidence interval [CI]: .-.) less likely to discontinue the enrollment method compared to women who experienced moderate/severe side effects always. Women who experienced mild side effects were even less likely to discontinue (AOR: .;  percent CI: .-.). Study results suggest side effect severity and frequency are more important factors than simply the experience of a side effect in understanding contraceptive discontinuation. DHS and other national surveys should expand their exploration of side effects to include questions asked of current users. BACKGROUNDContraceptive discontinuation for reasons other than wanting a child or having no need for contraception (e.g., husband not living at home, not having or infrequent sex, menopausal/hysterectomy, or infertility) can lead to unintended pregnancies. It is estimated that in low-and middle-income countries, approximately one-third of all unintended

Contributions of side effects to contraceptive discontinuation and method switch among Kenyan women: a prospective cohort study

“…Despite the high burden of side effects, many women continued using their initial contraceptive method. Our findings are consistent with recent evidence from a cohort study in India, which found that half of women who experienced side effects were still using their initial method at 6 months 44 . Adjusting for side effects, risk of discontinuation was higher among women who felt ‘very dissatisfied’ with their method but not among those who were less than fully satisfied with their method.…”

“…We also did not measure the individual’s ability to access affordable contraceptive services should they wish to switch or discontinue their current method (which, in the case of LARC methods, requires provider removal). All of these may be important explanatory factors in switch and discontinuation 44,48 . Even where contraceptive services are available and generally free, recent evidence from Kenya has shown that provider barriers to LARC removal may restrict women’s ability freely to decide to switch or stop LARC use 18 …”

“…All of these may be important explanatory factors in switch and discontinuation. 44,48 Even where contraceptive services are available and generally free, recent evidence from Kenya has shown that provider barriers to LARC removal may restrict women's ability freely to decide to switch or stop LARC use. 18…”

Association between experience of specific side-effects and contraceptive switching and discontinuation in Uganda: results from a longitudinal study

“…This limits our ability to compare our findings to other studies and underscores the critical need to explore these areas of contraceptive use and experience more fully. We also note that we did not assess severity or frequency of side-effects; women who experience more severe side-effects or more frequent side-effects may discontinue at higher rates than others as Jain and colleagues found in India, adding further nuance to understanding the effect of side-effects on contraceptive behavior [ 26 ].…”

“…Tolerability of specific side-effects may differ for a variety of social, cultural, and economic reasons; how side-effects are interpreted, treated (e.g. availability and accessibility to menstrual hygiene products or treatment for cramping), and the economic and physical consequences when they are experienced are heavily influenced by context and quality of available services [ 6 , 10 , 24 – 26 ]. Findings from high-income countries should not, therefore, be applied to LMIC contexts nor should findings from one LMIC be rotely applied to another.…”