Population Council Research that makes a difference

2011 International Conference on Family Planning
29 November–2 December 2011

Abstract

"Contraceptive use dynamics in Pakistan"
Syeda Saman Naz, Arshad Mahmood, and Peter C. Miller

Significance/Background
In order to implement the family planning program, it is important to know how people use contraceptive methods, how well these methods work, what problems they have and what they think of them. This paper analyses the data to study contraceptive use-dynamics (discontinuation, failure and switching) in Pakistan. There have been many studies about contraceptive use prevalence but little is known about the contraceptive use-dynamics. The latest Pakistan Demographic and Health Survey 2006–07 indicates stagnation in contraceptive use at 30%. Despite no notable increase in the CPR, 'ever use' of family planning methods has increased during the past decade to 49%. This implies that almost half of currently married women have used contraceptives (modern or traditional methods) at least one time, indicating that a significant share of women have discontinued the use of family planning. These figures underscore the practical importance of studying contraceptive use-dynamics and their relevance to an understanding of the ability of couples in a country like Pakistan to achieve their reproductive intentions.

Main Question/Hypothesis
To examine the contraceptive discontinuation, failure and switching rates and study if they differ by the contraceptive method used and the socio-demographic characteristics of women.

Data and Methods
The data is derived from the FALAH (Family Advancement for Life and Health) project baseline survey of the 29 districts across Pakistan. FALAH is a USAID-funded five-year project to diversify family planning services in selected districts of Pakistan's four provinces, being carried out by a consortium of organizations led by the Population Council. The sample size is 17,124 women, which is almost double the sample size of the recent PDHS 2006–07. This is a unique data in Pakistan that uses standard Demographic and Health Surveys format to collect information on monthly contraceptive history of women. Analysis is based on 11,003 episodes of contraceptive usage by women in 4 years prior to the survey. Single and multi decrement life table analysis was performed.

Results/Key Findings

• Universal knowledge of at least one modern contraceptive method (99%).
• Twenty-nine percent of the women were current users of contraceptives.

Contraceptive discontinuation

• Forty-five percent of the women discontinued their contraceptive method within a year.
• Hormonal methods have the higher discontinuation rates than the natural methods.
• A quarter of injectable users did not go for the second dose.
• IUD had the lowest discontinuation rates.
• Women whose intent was to space between births were more likely to discontinue than the women wanting to limit their family size.
• A third of the total discontinuations were caused by the side effects (29%).
• Contraceptive continuation rate (at one year) could be improved by 10% if discontinuations caused by the side effects were eliminated.

Contraceptive switching

• Only a fifth of the discontinued episodes switched to another method (21%).
• Twelve month switching rate was 12%.
• Out of those who switched 53% adopted a less effective method.
• Half of the modern contraceptive users switched to less effective traditional and barrier methods which have higher failure rates. This is indicated by the high unwanted pregnancy (one in four births; PDHS 2006–07) and abortion rates (29 per 1000 women aged 15–49 years; Sathar et al, 2007).

Contraceptive failure

• More than 1 in 5 discontinuations were caused by method failure (18%).
• Twelve month failure rate was 7%.
• Failure was higher for traditional and couple methods.
• Contraceptive continuation rate (at one year) could be improved by 6% if discontinuations caused by the method failure were eliminated.

Knowledge Contribution
The results of this study will help to reinforce the major but much neglected problems of contraceptive discontinuation, failure and inadequate switching to alternative methods in the family planning program of Pakistan.

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