Oral contraceptive discontinuation and its aftermath in 19 developing countries.
BACKGROUND
The purpose of the article was to document oral contraceptive (OC) discontinuation and switching in a large number of low- and middle-income countries, and to assess the effects of women's education and reason for use (spacing vs. limitation). An attempt was made to explain intercountry variations.


METHODS
Calendar data from 19 Demographic and Health Surveys conducted between 1999 and 2005 were used. Data were analyzed by single- and multiple-decrement life tables and by Cox proportional hazard model.


RESULTS
The probability of stopping OC use within 12 months for reasons that implied dissatisfaction with the method ranged from 15% in Indonesia to over 40% in Bolivia and Peru with a median value of 28%. On average, 35% switched to a modern method within 3 months and 16% to a less effective 'traditional' method. Both education and reason for use were strongly related to the probability of switching to a modern method. Discontinuation was lower and switching higher in countries judged to have strong family planning programs.


CONCLUSIONS
Both discontinuation of use and inadequate switching to alternative methods are major but neglected problems in the family planning services of many developing countries.
Ali
Mohamed M
MM
Regional Office for the Eastern Mediterranean, World Health Organization, Cairo P.O. Box 11371, Egypt. alim@emro.who.int
Cleland
John
J
D003267:Contraception / Q000706:statistics & numerical data / Q000639:trends*; D003268:Contraception Behavior / Q000706:statistics & numerical data / Q000639:trends*; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D003906:Developing Countries / Q000706:statistics & numerical data*; D005193:Family Planning Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D016016:Proportional Hazards Models; D028761:Withholding Treatment / Q000706:statistics & numerical data*
D003271:Contraceptive Agents, Female