High contraceptive discontinuation results in millions of women having an unmet need for contraception. However, its contribution to unintended fertility is not known. Reproductive calendar data in Demographic and Health Surveys in 36 countries are used to estimate the percent of unintended recent births attributable to contraceptive discontinuation. Contraceptive discontinuation accounted for about one-third of unintended recent births in all countries together. Method failure and contraception discontinued for other reasons accounted for most of this contribution. The contribution of contraceptive discontinuation to unintended births increases with the use of modern methods but decreases as method composition at a given level of contraceptive prevalence shifts toward methods with higher effectiveness and longer continuation. High contraceptive discontinuation in the past without changes in fertility intentions has resulted in millions of unintended births. This contribution is likely to increase with the anticipated increase in the use of modern methods. Enabling current users to reduce method failure and encouraging them to switch to another method after discontinuing the use of the original method will be an effective strategy to reduce contraceptive discontinuation and its contribution to unintended births.
Published in a peer-reviewed journal of the Population Council. Anrudh K. Jain is Distinguished Scholar, Population Council, New York. William Winfrey is Senior Economist, Avenir Health, Glastonbury, CT. This report is prepared under a project entitled "Measuring and Monitoring Quality of Services and Quality of Care," funded by a grant from the David and Lucile Packard Foundation to the Population Council. The authors gratefully acknowledge the assistance of Nadia Carvalho in data analysis and the helpful suggestions received on an earlier version from Ian Askew and John W. Townsend.