Why do women discontinue contraception and what are the post-discontinuation outcomes? Evidence from the Arusha Region, Tanzania

Figures & data

Figure 1. Flowchart of events included in contraceptive calendar

Note: 12,209 episodes are from 3950 women, and the analytical sample of 2623 episodes are from 1966 women in Arusha region, Tanzania

Table 1. Distribution of women, by background characteristics, Arusha, 2018

	Number n = 1966	%
Age (years)
16–19	55	2.8
20–24	456	23.2
25–29	547	27.8
30–34	441	22.4
35–39	306	15.6
40–44	160	8.1
Education
None	49	2.5
Primary	1121	57.0
Secondary	652	33.2
Higher than secondary	143	7.3
Wealth index
Poorest	333	0.2
Poorer	175	0.1
Medium	334	0.2
Richer	899	0.5
Richest	225	0.1
Marital status
Never married	218	0.1
Currently married	1597	0.8
Formerly married	151	0.1
Contraceptive use
Current user of contraception	1567	0.8
Current user of modern contraception	1238	0.6
	Mean	SD
Distance to health facility visited for contraceptive methods (km)	5.63	8.0
Number of contraceptive methods known (0–13)	10.57	1.3
Number of miscarriages	0.21	0.5
Number of children	2.12	1.3

Note: the sample is 1966 women aged 16–44 years in Arusha region, Tanzania.

Table 2. Number and per cent of contraceptive episodes and median duration of use, by type of method, Arusha, 2018

Methods	Frequency (N)	Per cent (%)	Mean duration (months)
IUD	109	4.2	11.5
Injectables	735	28	10.4
Implants	582	22.2	13.0
Pills	372	14.2	9.1
Male condoms	204	7.8	6.5
Rhythm	416	15.9	11.2
Withdrawal	94	3.6	9.1
Other	111	4.2	7.5
Total	2623	100.00	10.6

Notes: The sample is 2623 episodes which were initiated after the baseline interview among 1966 women. “Other” includes lactational amenorrhoea method (LAM), female condoms, emergency contraception, other modern method, and other traditional method.

Figure 2. Per cent discontinuing use by 12th month, by type of contraceptive method, Arusha, 2018

Notes: The sample is 2623 episodes which were initiated after the baseline interview among 1966 women. “Other” methods include IUD and withdrawal due to the small size, in addition to Lactational amenorrhoea

Table 3. Percentage discontinuing use, by type of method and reason, Arusha, 2018

	Reasons
Method discontinued	Method failure	Desire to become pregnant	Other reasons	Side effects/health concerns	Wanted more effective method	Other method related	Other/DK	All reasons
Injectables	2.5	9.2	4.6	19.8	2.9	3.0	5.9	47.9
Implants	0.0	5.6	0.2	5.9	0.0	0.3	0.4	12.3
Pills	4.9	12.5	6.9	19.7	4.7	6.2	3.5	58.6
Male condoms	3.1	9.5	26.1	6.6	6.4	0.0	8.4	60.1
Rhythm	9.7	12.2	10.4	3.5	8.6	1.8	0.5	46.7
Other	5.8	6.3	9.9	6.0	24.1	0.9	3.6	56.5
All methods	4.2	9.3	7.3	11.7	6.4	2.3	3.4	44.6

Notes: The sample is 2623 episodes which were initiated after the baseline interview among 1966 women. “Other reasons” include “infrequent sex/husband away”, “difficult to get pregnant/menopause”, and “marital dissolution”. The rate is based on the survival model (multiple-decrement life-table approach). “Other” methods include IUD and withdrawal due to the small size, in addition to lactational amenorrhoea method (LAM), female condoms, emergency contraception, other modern method, and other traditional method.

Table 4. Status at three months after discontinuing for any reason, by method discontinued, Arusha, 2018

Discontinued method	No method used	Method switched to:					Pregnancy	Other	%
		Injectable	Implants	Pills	Male condoms	Rhythm
Panel A: Total
Injectables	38.1	8.4	16.5	10.0	0.8	5.5	15.5	5.2	100.0
Implants	31.1	21.6	4.1	13.5	1.4	8.1	17.6	2.7	100.0
Pills	30.5	21.3	5.1	3.6	2.5	8.1	22.3	6.6	100.0
Condoms	48.3	8.3	4.2	2.5	10.0	10.8	10.0	5.8	100.0
Rhythm	21.8	7.5	4.6	1.1	4.6	12.6	42.0	5.7	100.0
Other	24.2	15.2	8.3	8.3	5.3	11.4	18.2	9.1	100.0
Total	33.0	12.3	9.3	6.6	3.3	8.6	20.9	5.9	100.0
Panel B: Among discontinued episodes because of “desire to get pregnant”
Injectables	56.9	0.0	0.0	0.0	1.5	0.0	40.0	1.5	100.0
Implants	36.8	0.0	0.0	0.0	0.0	5.3	52.6	5.3	100.0
Pills	46.5	0.0	0.0	0.0	0.0	0.0	46.5	7.0	100.0
Condoms	53.8	0.0	0.0	0.0	0.0	0.0	38.5	7.7	100.0
Rhythm	17.8	0.0	0.0	0.0	0.0	4.4	71.1	6.7	100.0
Other	52.9	0.0	0.0	0.0	0.0	0.0	47.1	0.0	100.0
Total	43.6	0.0	0.0	0.0	0.5	1.5	50.0	4.5	100.0
Panel C: Among discontinued episodes because of other reasons
Injectables	34.2	10.1	19.6	12.0	0.6	6.6	10.4	6.3	100.0
Implants	29.1	29.1	5.5	18.2	1.8	9.1	5.5	1.8	100.0
Pills	26.0	27.3	6.5	4.5	3.2	10.4	15.6	6.5	100.0
Condoms	47.7	9.3	4.7	2.8	11.2	12.1	6.5	5.6	100.0
Rhythm	23.3	10.1	6.2	1.6	6.2	15.5	31.8	5.4	100.0
Other	20.0	17.4	9.6	9.6	6.1	13.0	13.9	10.4	100.0
Total	30.6	15.2	11.3	8.1	4.0	10.3	14.2	6.4	100.0

Notes: “Other” in discontinued method includes IUD, female condoms, emergency contraception, withdrawal, other modern/traditional methods. “Other” in the next event includes IUD, other modern/traditional methods, and termination. The numbers represent the % distribution.

Table 5. Odds ratios of method discontinuation, by contraceptive method and background characteristics

	Discontinued (OR [95% CI])
Method	Overall	Injectables	Implants	Pills	Condoms	Rhythm
Sample	All	Among users of the method
	(1)	(2)	(3)	(4)	(5)	(6)
Age (reference = 16–19)
Age 20–24	0.701 [0.416,1.180]	0.564 [0.228,1.398]	2.120 [0.256,17.577]	0.745 [0.047,11.929]	0.951 [0.202,4.471]	0.390 [0.115,1.325]
Age 25–29	0.733 [0.428,1.254]	0.432* [0.170,1.101]	3.317 [0.397,27.687]	0.814 [0.053,12.418]	1.137 [0.234,5.521]	0.549 [0.152,1.986]
Age 30–34	0.644 [0.367,1.129]	0.381* [0.144,1.007]	3.464 [0.391,30.649]	0.420 [0.026,6.801]	1.247 [0.204,7.638]	0.296* [0.075,1.160]
Age 35–39	0.553* [0.299,1.026]	0.605 [0.214,1.708]	3.299 [0.335,32.487]	0.347 [0.021,5.805]	0.906 [0.130,6.338]	0.159** [0.039,0.654]
Age 40–44	0.619 [0.322,1.189]	0.365* [0.121,1.103]	6.767 [0.569,80.485]	0.532 [0.028,10.025]	3.267 [0.339,31.465]	0.148** [0.027,0.808]
Education (reference = none)
Primary	0.878 [0.548,1.408]	1.048 [0.459,2.394]	191347.434*** [82568.281,443437.116]	0.386 [0.108,1.372]	0.990 [0.076,12.865]	1.953 [0.197,19.371]
Secondary	0.980 [0.596,1.612]	0.902 [0.381,2.131]	209036.309*** [79598.525,548957.139]	0.382 [0.100,1.465]	1.015 [0.071,14.457]	3.300 [0.330,32.982]
Higher than secondary	1.015 [0.552,1.869]	1.448 [0.386,5.427]	48451.015*** [6018.774,390029.766]	0.243* [0.047,1.249]	1.397 [0.081,24.042]	3.451 [0.317,37.597]
Wealth index (reference = poorest)
Poorer	0.864 [0.626,1.194]	0.969 [0.541,1.734]	1.317 [0.466,3.721]	1.167 [0.381,3.580]	0.276* [0.067,1.125]	0.785 [0.289,2.137]
Medium	1.070 [0.800,1.431]	1.325 [0.793,2.212]	1.758 [0.751,4.113]	0.691 [0.304,1.572]	0.345 [0.096,1.237]	1.510 [0.644,3.541]
Richer	0.933 [0.731,1.192]	1.369 [0.892,2.100]	1.613 [0.754,3.454]	0.719 [0.360,1.437]	0.278** [0.095,0.813]	0.621 [0.332,1.160]
Richest	1.053 [0.748,1.483]	1.571 [0.734,3.362]	0.948 [0.243,3.695]	0.836 [0.340,2.056]	0.238** [0.057,0.992]	0.558 [0.257,1.213]
Marital status (reference = never married)
Currently married	0.828 [0.609,1.126]	0.844 [0.447,1.591]	0.941 [0.341,2.601]	0.255** [0.085,0.771]	0.742 [0.282,1.952]	1.721* [0.902,3.280]
Formerly married	1.222 [0.806,1.851]	1.656 [0.709,3.868]	0.973 [0.254,3.729]	1.167 [0.243,5.608]	0.559 [0.165,1.893]	2.227* [0.860,5.762]
Method discontinued (reference = injectables)
Implants	0.114*** [0.086,0.153]
Pills	0.988 [0.765,1.276]
Condoms	1.044 [0.726,1.502]
Rhythm	0.535*** [0.410,0.699]
Other	0.646*** [0.485,0.862]
Distance to health facility visited for contraceptive methods (km)	1.000 [0.993,1.008]	1.035** [1.004,1.067]	1.004 [0.990,1.018]	1.005 [0.964,1.048]	0.935** [0.887,0.986]	0.955*** [0.925,0.986]
Number of contraceptive methods known (0–13)	1.036 [0.969,1.107]	1.039 [0.918,1.175]	1.012 [0.791,1.296]	1.082 [0.913,1.281]	1.086 [0.814,1.448]	1.009 [0.850,1.197]
Number of miscarriage	1.223*** [1.062,1.409]	1.260 [0.901,1.764]	1.613** [1.060,2.454]	1.105 [0.780,1.565]	0.571 [0.285,1.144]	1.281 [0.900,1.822]
Number of children	0.902** [0.818,0.996]	0.950 [0.805,1.121]	0.588*** [0.416,0.832]	0.922 [0.702,1.210]	0.554*** [0.360,0.852]	1.037 [0.811,1.327]
N	2616	735	580	370	204	414

Notes: the sample for column (1) is total sample of 2616 episodes which has no missing information of covariates, and the sample for columns (2) to (6) includes the episodes that use each contraceptive method. The clustered standard error by woman is used.

*Significant at 10%.

**Significant at 5%.

***Significant at 1%.

Table 6. Odds ratios of method discontinuation, by reason of discontinuation and background characteristics

	Why discontinued? (OR [95% CI])
	Method failure (1)	Want to get pregnant (2)	Fertility problem (3)	Side effect (4)	Want more effective methods (5)
Age (reference = 16–19)
20–24	1.395 [0.334,5.820]	4.816 [0.581,39.913]	0.541 [0.201,1.458]	1.343 [0.594,3.036]	0.731 [0.221,2.419]
25–29	1.191 [0.291,4.877]	9.405** [1.139,77.687]	0.630 [0.210,1.895]	1.086 [0.464,2.543]	0.518 [0.149,1.794]
30–34	0.483 [0.107,2.169]	10.704** [1.277,89.748]	1.034 [0.277,3.856]	1.465 [0.572,3.750]	0.432 [0.117,1.588]
35–39	0.230* [0.044,1.193]	9.566** [1.088,84.105]	1.814 [0.515,6.393]	1.322 [0.444,3.936]	0.542 [0.142,2.076]
40–44	0.130** [0.017,0.976]	7.347* [0.812,66.467]	2.988 [0.706,12.650]	0.534 [0.168,1.697]	0.410 [0.088,1.902]
Education (reference = none)
Primary	0.370** [0.138,0.994]	0.485 [0.168,1.399]	2.158 [0.502,9.277]	1.150 [0.532,2.487]	1.649 [0.489,5.565]
Secondary	0.420 [0.145,1.220]	0.442 [0.149,1.315]	2.126 [0.466,9.706]	1.020 [0.447,2.328]	1.799 [0.514,6.299]
Higher than secondary	0.152** [0.032,0.724]	0.542 [0.157,1.872]	3.175 [0.604,16.696]	0.841 [0.290,2.437]	2.741 [0.702,10.699]
Wealth index (reference = poorest)
Poorer	0.800 [0.274,2.339]	0.756 [0.342,1.670]	0.994 [0.349,2.827]	1.432 [0.773,2.651]	0.765 [0.316,1.857]
Medium	1.240 [0.575,2.673]	0.787 [0.432,1.432]	1.715 [0.738,3.984]	1.082 [0.613,1.908]	0.486** [0.240,0.982]
Richer	0.892 [0.472,1.688]	0.800 [0.482,1.330]	1.728 [0.830,3.598]	1.032 [0.640,1.662]	0.675 [0.392,1.163]
Richest	0.671 [0.235,1.920]	1.563 [0.795,3.073]	1.467 [0.576,3.735]	0.789 [0.388,1.603]	0.445** [0.208,0.949]
Marital status (reference = never married)
Currently married	1.610 [0.682,3.799]	22.041*** [5.023,96.709]	0.061*** [0.033,0.114]	1.236 [0.723,2.112]	3.534*** [1.650,7.567]
Formerly married	0.786 [0.215,2.869]	6.322** [1.241,32.220]	0.458** [0.215,0.976]	1.108 [0.495,2.480]	0.917 [0.294,2.860]
Method discontinued (reference = injectables)
Implants	0.241 [0.033,1.775]	1.460 [0.797,2.674]	0.479 [0.116,1.976]	2.276*** [1.344,3.854]
Pills	1.312 [0.640,2.689]	1.096 [0.694,1.730]	1.667 [0.819,3.392]	0.739 [0.507,1.078]	0.936 [0.489,1.792]
Condoms	1.697 [0.657,4.382]	1.220 [0.607,2.451]	3.998*** [2.019,7.919]	0.142*** [0.060,0.337]	2.675** [1.234,5.801]
Rhythm	8.567*** [4.582,16.018]	1.531* [0.956,2.451]	1.697 [0.779,3.694]	0.075*** [0.031,0.181]	4.090*** [2.358,7.095]
Other	2.410** [1.174,4.949]	0.473** [0.253,0.884]	2.682** [1.233,5.830]	0.147*** [0.080,0.270]	9.103*** [5.272,15.720]
Distance to health facility visited for contraceptive methods (km)	0.988 [0.958,1.019]	1.007 [0.995,1.019]	1.013 [0.993,1.033]	0.976* [0.949,1.003]	1.000 [0.983,1.017]
Number of contraceptive methods known (0–13)	1.115 [0.942,1.319]	0.923 [0.810,1.052]	0.942 [0.793,1.119]	0.952 [0.839,1.082]	1.151* [0.989,1.340]
Number of miscarriages	1.187 [0.725,1.944]	1.707*** [1.311,2.222]	0.789 [0.499,1.247]	0.872 [0.639,1.191]	0.778 [0.553,1.096]
Number of children	1.553*** [1.238,1.948]	0.748*** [0.609,0.918]	0.979 [0.745,1.287]	0.954 [0.783,1.162]	1.113 [0.916,1.351]
N	1150	1150	1150	1150	1074

Notes: the sample is 1150 episodes which got discontinued and have no missing information on covariates. The clustered standard error by woman is used.

*Significant at 10%.

**Significant at 5%.

***Significant at 1%.