Contraceptive switch and abandonment among women using the pill, condoms and injectables in Brazil

Abstract

Objective

The aim of our study was to assess the covariates of contraceptive switching and abandonment among Brazilian women stratified by oral pills, condoms and injectables.

Materials and Methods

Women attending primary health care services in three Brazilian mid- to large-sized cities were interviewed face-to-face about their contraceptive practices (n = 2,051). Data were collected using a contraceptive calendar. Analysis included estimates using Kaplan-Meier multiple-decrement life-table probabilities and discrete-time hazards modelling of switching from a method to another or to no method.

Results

Among 3,280 segments of contraceptive use, we observed that five-year contraceptive switching rates ranged from 34.9% among injectable users to 56.1% among pill users. Of particular concern were the high discontinuation rates of abandonment, which ranged from 50.9% among injectable users to 77.4% among pill users. Covariates of method switching and abandonment varied by type of method, but age, race/ethnicity, religion and relationship status must be highlighted as key elements of discontinuation.

Conclusion

Contraceptive method switching and abandoning are frequent outcomes of contraceptive use. Understanding the factors that shape women’s decisions to continue or discontinue the use of a contraceptive method can help tailoring comprehensive contraceptive counselling that meet their expectations and reproductive needs when starting using a method.

SHORT CONDENSATION

Contraceptive discontinuation among women in need of contraception may difficult the achievement of their fertility desires, which can lead to unintended pregnancies.

摘要

目的:我们研究的目的是评估口服避孕药、避孕套和注射剂对巴西妇女避孕转换和放弃的协变量。

材料和方法:对在巴西三个大中型城市接受初级卫生保健服务的妇女进行了面谈, 了解她们的避孕做法(n = 2,051)。使用避孕日历收集数据。分析包括对从一种方法切换到另一种方法或不切换到任何方法的使用Kaplan-Meier多减量生命表概率和离散时间风险建模的估计。结果:在3,280个避孕药具使用人群中, 我们观察到5年避孕药具转换率在注射使用者中为34.9%, 在口服避孕药使用者中为56.1%。特别值得关注的是很高的放弃停药率, 在注射吸毒者中为50.9%, 在药丸使用者中为77.4%。方法转换和放弃的协变量因方法类型的不同而不同, 但年龄、种族/民族、宗教和关系状况必须被强调为停止使用的关键因素。

结论:避孕方法的转换和放弃是常用的避孕方法。了解影响妇女决定继续或停止使用避孕方法的因素, 有助于在开始使用一种方法时提供全面的避孕咨询, 以满足她们的期望和生殖需要。

小结：

在需要避孕的妇女中停止避孕可能难以实现她们的生育愿望, 这可能导致意外怀孕。

Keywords:

• Contraception
• oral contraceptives
• condoms
• sexual and reproductive health
• sexual behaviour

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo/FAPESP [grant number 2014/02447-5], and Conselho Nacional de Desenvolvimento Científico e Tecnológico/CNPq [grant number 440577/2014-4].