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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 29  |  Issue : 4  |  Page : 996-999

Discontinuation of contraception in rural and urban areas in Menoufia Governorate


1 Department of Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission24-Dec-2014
Date of Acceptance04-May-2015
Date of Web Publication21-Mar-2017

Correspondence Address:
Reem A Abo Al Agha
Tanta, Algharbia Governorate, 31511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.202531

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  Abstract 

Objective
The aim of this study was to study the reasons for discontinuation of contraception in rural and urban areas.
Background
Imperfect or incorrect use of contraception by women often leads to contraceptive discontinuation. Therefore, this study was conducted to assess the reasons for discontinuation of contraception.
Materials and methods
This retrospective study was performed on 500 married women of reproductive age (20–50 years) who were using or discontinuing the use of any type of contraceptive method. This study was performed from 2012 to 2013.
Results
The highest discontinuation rates were observed for pills (40%), followed by injectables (37%). IUD (intrauterine device) had the lowest discontinuation rate. Thus, the main reason for discontinuation of contraception was side effects of the methods.
Conclusion
The reasons for discontinuation of contraceptive use primarily include side effects, desire to conceive, and contraceptive availability and acceptability. Family planning programmers and providers need to reach far and rural areas to help the couples successfully maintain and continue contraceptive use.

Keywords: contraception, discontinuation, rural areas, unintended pregnancy, urban areas


How to cite this article:
Anwar El Shazly HM, Emara MA, Abo Al Agha RA. Discontinuation of contraception in rural and urban areas in Menoufia Governorate. Menoufia Med J 2016;29:996-9

How to cite this URL:
Anwar El Shazly HM, Emara MA, Abo Al Agha RA. Discontinuation of contraception in rural and urban areas in Menoufia Governorate. Menoufia Med J [serial online] 2016 [cited 2020 Feb 24];29:996-9. Available from: http://www.mmj.eg.net/text.asp?2016/29/4/996/202531


  Introduction Top


Contraception is the intentional prevention of conception through the use of various devices, sexual practices, chemicals, drugs, or surgical procedures. Thus, something (or behavior) that prevents pregnancy is a contraceptive. There are several types of contraceptives that have been officially labeled as such, because they have shown reliability in preventing conception [1].

It is important that women who use contraception to delay or avoid pregnancy continue to use an effective method until they want another child or no longer need contraception. Premature discontinuation can lead to unplanned pregnancy and unwanted birth, which in turn may result in negative public health consequences such as increased maternal, neonatal, and infant morbidity and/or mortality [2].

In an ideal world, every woman would find a contraceptive method suited to her age, union status, and desire for future conceptions, and she would use that method until she is no longer exposed to risk of an unintended pregnancy, or until changing life circumstances lead her to choose a different method [3].

Contraceptive discontinuation is a common event. Many studies have examined the association between family planning service environment, including access, cost, and quality of services, and the continued use of contraceptives, the individual characteristics of women who are most likely to discontinue, including age, parity, marital status, and fertility desires, and the influence of side effects [4].

In developing countries, the percentage of married couples using any method of contraception has increased. As contraceptive practice becomes more widespread, the avoidance of unintended pregnancies becomes less dependent on contraceptive nonuse and more dependent on the ability and willingness of couples to use methods effectively, to use them persistently, and to quickly switch to alternative methods as and when the need arises [5].


  Materials and Methods Top


This retrospective study was conducted at Menoufia Governorate, Egypt, at the family planning centers in Shebin El-Kom, Berket El-Sabei, and Menouf. The study population included 500 married women of reproductive age (20–50 years) who were using or discontinuing the use of any contraceptive method and were assessed for the same. Data on the following subject areas were collected: social and demographic characteristics, birth histories, reproductive and family histories, a history of contraceptive use and discontinuation, perception of health service quality, motivation to avoid pregnancies, and environment of decision-making. Discontinuation occurred for logistical, social, and medical reasons. Common reasons for discontinuation included side effects, husband's opposition, and provider and/or clinic restrictions. These reasons were classified into method-related and non-method-related reasons. Method-related reasons for discontinuation included the following: method failure, switching of methods, abandonment by users who did not require contraceptives (due to desire for pregnancy or reduced risk of pregnancy), and abandonment by users who required contraceptives (i.e. those at risk of unintended pregnancy). This last type, abandonment of users in need, is the focus of this dissertation. It has been estimated that at least half of the women using contraceptives switch between two hormonal methods, pills and injectables. The probability of resuming the use of contraceptive methods was 10% lower when discontinuation was related to contraceptive failure compared with discontinuation that was not related to contraceptive failure. Unintended pregnancies may be due to failure of the method caused by incorrect usage ([Table 1]).
Table 1 Reasons for discontinuation

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  Results Top


As regards the methods, the highest discontinuation rates were observed for pills and prolonged breastfeeding (40% each), followed by injectables (37%). IUD had the lowest discontinuation rate; users discontinued within 12 months of adopting in only 12% of all episodes of use. The reasons for discontinuation varied on the basis of the method, and side effects or health concerns were the most frequent reasons for discontinuation among users of injectables (21%), pills (12%), and IUD (6%). Method failure was most often the cause of discontinuation among condom users (8%) and least often mentioned as a reason for discontinuation of IUD and injectables (about 1%). Pill and injectable users were more likely to discontinue use compared with users of other methods, because they wanted to become pregnant or because of other fertility-related reasons, including infrequent sex. Wanting an effective method was a more frequent motivation for discontinuation among users of condom (7%) and prolonged breastfeeding (5%) compared with users of other methods. The results indicate that users were most likely to adopt a new method after discontinuing condom and prolonged breastfeeding and least likely to switch to another method if they were using the IUD. More than one-third of all discontinuations occurred because the user wanted to conceive. Wanting another child was the most often cited reason for discontinuation among IUD users (49%) and pill users (33%). Side effects and health concerns accounted for around three of 10 discontinuations. They were cited as the reason for more than half of all discontinuations among injectable users (52%) and were the second most common cause of discontinuation among IUD and pill users (32 and 26%, respectively). Nine percent of all discontinuations were the result of method failure – that is, the woman became pregnant when using a method. Method failure was most often mentioned as the reason for discontinuation of condom (30%) and also was frequently a factor in discontinuation of pill and prolonged breastfeeding (15% each). Dissatisfaction with the method was a major factor in discontinuations for some methods. In case of prolonged breastfeeding, for example, 51% of discontinuations were because the woman found the method inconvenient to use. Concern about method effectiveness was a factor in more than one out of 10 (14%) individuals who discontinued the use of condom, and in 16% it was due to the husband's unwillingness to use the method. Factors that reduced or eliminated the risk of pregnancy (e.g., infrequent sex/husband away, difficulty in getting pregnant/menopause, and marital dissolution) accounted for more than 11% of discontinuations. An overall 64% of individuals intended to use family planning at some time in the future, 29% did not plan to use in the future, and the remaining nonusers were unsure about their intentions. The intention to use family planning varies with the number of living children the nonuser has. Overall, the proportion of individuals who stated that they planned to use family planning in the future decreased from 80% among women with one child to 41% among women with four or more children. Among childless women, six of 10 intended to use in the future. Method-related reasons were cited by a significant proportion of nonusers: 10% had health concerns and 7% mentioned fear of side effects. Opposition to use, either by the woman or by her husband, was a factor in 6% of nonusers.


  Discussion Top


Contraceptive discontinuations contribute substantially to the total fertility rate, unwanted pregnancies, and induced abortions. Among women who use contraceptives, many discontinue despite a continuing desire to avoid pregnancy and conceive when still using contraception, or switch from highly effective contraceptive methods to less effective methods. Numerous reports in the past have focused on the levels, trends, and reasons why women do not use or do not intend to use contraceptives [6]. These reports focused on women who have begun using contraceptives but who discontinue using them when still in need of contraceptives or wishing to avoid pregnancy. Age, parity, education, partner's desired fertility, community-level contraceptive prevalence, and the region in which women live were all associated with contraceptive switching, failure, or discontinuing when still in need of contraception. Unfortunately, the family planning programs in many developing countries are yet to meet this goal. The proportion of women who are sexually active and do not want to conceive but are not using family planning remains high and is increasing in many developing countries. Higher socioeconomic status has been shown to be associated with lower levels of failure and abandonment and higher levels of switching [7]. The typical-use failure rates for pill and condoms were 7.6 and 13.9%, respectively, and that for intrauterine contraceptives were 0.8% for the copper-T and 0.1% for the levonorgestrel-releasing intrauterine contraceptives [8].

The results indicate that 60% of currently married women in Egypt are using contraception. IUD, pill, and injectables are the most widely used methods. An overall 36% of currently married women interviewed in the EDHS were currently using IUD, 12% were relying on pill, and 7% were using injectables. Relatively small proportions of women were using other modern methods: 1% were using condom. Three percent of women reported the use of traditional methods [Figure 1] [9]. In developing countries the women face many health problems, particularly in rural areas. The main reasons for this are lack of education and healthcare centers and tribal customs that restrict women from clinical tests. In most of the rural areas most tribal customs forbid women from working and being visited by male doctors; as a result, most of the women do not go to hospital for checkups. Moreover, socioeconomic conditions of rural areas are highly responsible for the poor health of women [10].
Figure 1: Current use of methods.

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Bridging the gap between rural and urban areas' access to and use of reproductive healthcare is a major challenge for the governments. The rural–urban gap is particularly large in lower income countries in the region [Figure 2] [11].
Figure 2: Share of rural and urban deliveries taking place in health facilities.

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The contact with an outreach worker motivates a woman to continue using a contraceptive method. Visits and supply from family planning field workers would improve the quality of family planning services in general, and thereby also reduce discontinuation rates [12] ([Table 2]).
Table 2 Contraceptive discontinuation rates

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  Conclusion Top


The reasons for discontinuation of contraceptive use primarily include side effects, desire to conceive, and contraceptive availability. Side effect is the most common reason for discontinuation of contraceptive use.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
D Stacey. Health's disease and condition content is reviewed by the Medical Review Board. LMHC 2012; 30:34.  Back to cited text no. 1
    
2.
Austin C. Contraception and world religions: religions on birth control. Oxford Med J 2013; 39:4–9.  Back to cited text no. 2
    
3.
Vaughan B, Trussell J, Kost K, Singh S, Jones R. Discontinuation and resumption of contraceptive use: results from the 2002 National Survey of Family Growth. Contraception 2008; 78(4): 271–283.  Back to cited text no. 3
    
4.
Rama Rao S, Lcuesta M, Costello M. The link between qualities of care and contraceptive use international family planning perspective. International Perspectives on Sexual and Reproductive Health 2003; 29:76–83.  Back to cited text no. 4
    
5.
Ali MM, Cleland J. Oral contraceptive discontinuation and its aftermath in 19 developing countries. Contraception. 2010;81:22-9.   Back to cited text no. 5
    
6.
Sedgh GR, Hnssain A, Bankole H, Singh S. Women with an unmet need for contraception in developing countries and their reasons for not using a method. New York: Guttmacher Institute; 2012.  Back to cited text no. 6
    
7.
Rizvi F, Irfan G. Reasons for discontinuation of contraceptive methods among couples with different family size and educational status. J Ayub Med Coll Abbottabad 2012; 24:101-104.  Back to cited text no. 7
    
8.
Trussell J. Contraceptive failure in the United States. Contraception. 2011 May;83:397-404.  Back to cited text no. 8
    
9.
Egypt demographic and health surveys. Cairo, Egypt. Non use of family planning and intention of use (7) 2011; P 89: 93. Ministry of Health, Telephone: +20 2 27948555 and fax: +20 2 27924156.  Back to cited text no. 9
    
10.
Mariam S. Pal. Women in Pakistan: Country Briefing Paper (PDF). Asian Development Bank.(2000). ISBN 971-561-297-0.  Back to cited text no. 10
    
11.
Population Reference Bureau. Women's reproductive health in the Middle East and North Africa. Mena policy brief 2011.  Back to cited text no. 11
    
12.
Kaushalendra Kumar Singh, Tapan Kumar Roy and Brijesh Pratap Singh. Contraceptive discontinuation and switching patterns in Bangladesh. Genus 2010:66:63-88  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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