Contraceptive Discontinuation and Switching among Women in the Shai-Osudoku and Ningo Prampram Districts, Ghana

Abstract

INTRODUCTION: The intended and continued use of contraceptives is critical for attaining individual reproductive health goals and the prevention of unintended births that may be subject to induced abortions. Women who eventually overcome barriers and adopt a contraceptive method, encounter challenges that result in discontinuation, switching, or method failure. The occurrence of discontinuation for reasons other than the desire to conceive or switching to less effective methods, places women at an increased risk of unintended pregnancies. Identifying the period within which any form of discontinuation or switching is likely to occur and the reasons influencing these, will facilitate the identification of opportunities for providing a more accurate guide to users and encourage the delivery of context–appropriate support to users of family planning services. OBJECTIVE: This study sought to identify the occurrence of contraceptive discontinuation and switching among women in the Shai-Osudoku and Ningo Prampram districts, Ghana. METHODS: Individual in-depth interviews with 20 women reporting for reproductive and child health care services at the district Hospital were undertaken. This was complimented by a retrospective survey of 1,114 women using a structured questionnaire that incorporated the contraceptive calendar to collect reproductive histories. Cox regression and life table analysis was used to estimate discontinuation or switching. RESULTS: All method discontinuation for any reason at 12, 24 and 36 months after starting use were 4%, 18% and 38% respectively. This study identifies increasing age, number of children, use of contraceptives between births, after childbearing and receiving counselling on methods were associated with the reduced risk of contraceptive discontinuation at all times of follow up. A change in marital status and was associated with increased contraceptive discontinuation. At 12 months of use 10% of women discontinued because they are afraid of side effects of contraceptives, this increases to 37% at 24 months of use. Women who expressed fear of side effects of contraceptives had a 60% increase in the hazard of discontinuation at all times of follow up [HR=1.60 95% CI (1.17, 2.20)] whilst women who experienced side effects had a 50% increase in the hazard of discontinuation [HR=1.34; 95% CI (1.04, 1.75)] compared to women who discontinued for any other reason implying dissatisfaction with the method. A reduced need for contraceptives was associated with a 57% increase in the hazard of discontinuation at all times of follow up [HR=1.57; 95% CI (1.22, 2.01)]. Discontinuation of the pill was significantly increased compared to users of the male condom [HR=2.35, 95% CI (1.40, 3.97)] and compared to all other methods [HR=1.68; 95% CI (1.26, 2.25)]. Approximately 39% of switching occurred within the next month of use. Increasing number of children and counselling on methods were associated with a reduction in the hazard of discontinuation. The choice of switching to modern method was associated with an increased hazard at all times of follow up and the male condom was the preferred method for 20% of all switchers. Overall, 3.4% of pregnancies were identified as unintended, with the emergency contraceptive identified as the method with the most failures recorded. CONCLUSION: A reduced need for contraceptives, fear of side effects and the experience of side effects carry an increased risk of discontinuation compared to all other reasons. The strength of the influence that fears of side effects play in method selection, discontinuation and choice of method switched to where switching occurs, is a critical but amenable element if allocated the necessary attention.