title: Determinants of Method Switching among Social Franchise Clients Who Discontinued the Use of Intrauterine Contraceptive Device.
abstract: Introduction. Women who do not switch to alternate methods after contraceptive discontinuation, for reasons other than the desire to get pregnant or not needing it, are at obvious risk for unplanned pregnancies or unwanted births. This paper examines the factors that influence women to switch from Intrauterine Contraceptive Device (IUCD) to other methods instead of terminating contraceptive usage altogether. Methods. The data used for this study comes from a larger cross-sectional survey conducted in nine (9) randomly selected districts of Sindh and Punjab provinces of Pakistan, during January 2011. Using Stata 11.2, we analyzed data on 333 women, who reported the removal of IUCDs due to reasons other than the desire to get pregnant. Results. We found that 39.9% of the women do not switch to another method of contraception within one month after IUCD discontinuation. Use of contraception before IUCD insertion increases the odds for method switching by 2.26 times after removal. Similarly, postremoval follow-up by community health worker doubles (OR = 2.0) the chances of method switching. Compared with women who received free IUCD service (via voucher scheme), the method switching is 2.01 times higher among women who had paid for IUCD insertion. Conclusion. To increase the likelihood of method switching among IUCD discontinuers this study emphasizes the need for postremoval client counseling, follow-up by healthcare provider, improved choices to a wider range of contraceptives for poor clients, and user satisfaction.
authors.affiliation: Marie Stopes Society, Research, Monitoring & Evaluation Department-Technical Services, Karachi, Sindh 75500, Pakistan.
authors.forename: Waqas
authors.initials: W
authors.lastname: Hameed
authors.affiliation: Marie Stopes Society, Research, Monitoring & Evaluation Department-Technical Services, Karachi, Sindh 75500, Pakistan ; Department of Uro-Gynecology, University of Ghent, 9000 East Flanders, Belgium.
authors.forename: Syed Khurram
authors.initials: SK
authors.lastname: Azmat
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, 1211 Geneva, Switzerland.
authors.forename: Moazzam
authors.initials: M
authors.lastname: Ali
authors.affiliation: Marie Stopes Society, Research, Monitoring & Evaluation Department-Technical Services, Karachi, Sindh 75500, Pakistan.
authors.forename: Wajahat
authors.initials: W
authors.lastname: Hussain
authors.affiliation: Marie Stopes Society, Research, Monitoring & Evaluation Department-Technical Services, Karachi, Sindh 75500, Pakistan.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Mustafa
authors.affiliation: Marie Stopes Society, Research, Monitoring & Evaluation Department-Technical Services, Karachi, Sindh 75500, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ishaque
authors.affiliation: Marie Stopes Society, Research, Monitoring & Evaluation Department-Technical Services, Karachi, Sindh 75500, Pakistan.
authors.forename: Safdar
authors.initials: S
authors.lastname: Ali
authors.affiliation: Marie Stopes Society, Research, Monitoring & Evaluation Department-Technical Services, Karachi, Sindh 75500, Pakistan.
authors.forename: Aftab
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Department of Uro-Gynecology, University of Ghent, 9000 East Flanders, Belgium ; Department of Reproductive Health and Research, World Health Organization, 1211 Geneva, Switzerland.
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman