title: Temporal trends of copper-bearing intrauterine device discontinuation: a population-based birth-cohort study of contraceptive use among rural married women in China.
abstract: Copper-bearing intrauterine device (IUD) insertion for long-term contraceptive use is high in China, but there has been evidence that first-year discontinuation rate of copper-bearing IUD has also increased rapidly in recent years especially among rural married women. To investigate long-term use of copper-bearing IUD, the authors examined the 7-year temporal trends of copper-bearing IUD discontinuation in a population-based birth-cohort study among 720 rural married women in China, from 2004 to 2012. Women requesting contraception were followed-up twice per year after the insertion of IUD. The gross cumulative life table discontinuation rates were calculated for each of the main reasons for discontinuation as well as for all reasons combined. By the end of 7 years, 384 discontinuations were observed. With a stepped-up trend, the gross cumulative life table rate for discontinuation increased from 10.06 (95% confidence interval = 7.86-12.27) per 100 women by the first year to 52.69 (95% confidence interval = 48.94-56.44) per 100 women by the end of 7 years, which increased rapidly in the first 2 years after copper-bearing IUD insertion, flattened out gradually in the following 2 years, then increased again in the last 3 years. Among reported method failure, expulsion and side effects were the main reasons for discontinuation of the copper-bearing IUD but not pregnancy. Personal reasons, such as renewal by personal will had influenced copper-bearing IUD use since the second year and should not be neglected. Based on this study, the temporal trends of copper-bearing IUD discontinuation was in a stepped-up trend in 7 years after insertion. Both reported method failure (expulsion and side effect) and personal reason had effect on the discontinuation of copper-bearing IUD, but pregnancy was no more the most important reason affecting the use of copper-bearing IUD.
authors.affiliation: Wuhan University, Wuhan, China Kunming Medical University, Kunming, China 13577185636@163.com.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Wuhan University, Wuhan, China.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Tan
authors.affiliation: Yunnan Institute of Population and Family Planning Research, Kunming, China.
authors.forename: Xiangjing
authors.initials: X
authors.lastname: Song
authors.affiliation: Kunming Medical University, Kunming, China.
authors.forename: Kaining
authors.initials: K
authors.lastname: Zhang
authors.affiliation: Kunming Medical University, Kunming, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Fang
authors.affiliation: Yunnan Institute of Population and Family Planning Research, Kunming, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Peng
authors.affiliation: Family Planning Centre of Yuanmou County in Yunnan Province, Yuanmou, China.
authors.forename: Wencai
authors.initials: W
authors.lastname: Qi
authors.affiliation: Health Bureau of Yuanmou County, Yuanmou, China.
authors.forename: Zonghui
authors.initials: Z
authors.lastname: Nie
authors.affiliation: Maternal and Child Care Service Centre of Yuanmou County, Yuanmou, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.affiliation: Kunming Medical University, Kunming, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Deng
authors.affiliation: Kunming Medical University, Kunming, China.
authors.forename: Chaofang
authors.initials: C
authors.lastname: Yan
mesh_terms: D000328:Adult; D002681:China; D015331:Cohort Studies; D003267:Contraception / Q000379:methods; D003270:Contraceptive Agents; D005260:Female; D006801:Humans; D007434:Intrauterine Devices; D007435:Intrauterine Devices, Copper; D011247:Pregnancy; D057051:Product Recalls and Withdrawals; D012424:Rural Population; D018454:Spouses
chemical_list: D003270:Contraceptive Agents
keywords: copper-bearing intrauterine device; discontinuation; life table rates; temporal trends