MEASUREMENT

INDICATOR 18 : CONTRACEPTIVE DISCONTINUATION AND METHOD SWITCHING

INDICATOR NO.18A
Contraceptive discontinuation rate

Among women of reproductive age who began an episode of contraceptive use 3–62 months before being interviewed, the percentage of episodes where the specific method is discontinued within 12 months after beginning its use, reported by whether the woman discontinued while in need of contraception, discontinued because she is not in need of contraception, and the total all-reasons discontinuation rate, according to specific method

INDICATOR NO.18B
Contraceptive method switching

Among women of reproductive age who began an episode of contraceptive use 3–62 months before being interviewed, the percentage of episodes where the specific method is discontinued within 12 months after beginning its use, and use of a different method begins after no more than one month of non-contraceptive use

Over the past few years FP2020 has highlighted the importance of better understanding reasons for contraceptive discontinuation, which presents a challenge to achieving FP2020 goals. Following the publication of a report on discontinuation in 2015 and the inclusion of a special section on discontinuation in the 2016 FP2020 Progress Report, this year FP2020 added this indicator to its suite of Core Indicators.

Core Indicator 18 measures rates of contraceptive discontinuation (18a) and contraceptive method switching (18b) for each method. By measuring the rates at which women stop using methods, as well as the rates at which they switch from one method to another, Core Indicator 18 provides a fuller picture of the dynamics or churn of contraceptive use as women begin using a method, stop for a variety of reasons (most frequently because they want to become pregnant), start using a method again, or switch to a preferred or more effective method. Information on discontinuation complements existing measures of contraceptive prevalence, method mix, method availability, informed choice, and decision-making.

Learn more about discontinuation at: familyplanning2020.org/discontinuation

Core Indicator 18a estimates the total discontinuation rate for each method and disaggregates this estimate into two separate rates: 1) discontinuation while a woman is in need of contraception and 2) discontinuation because a woman is not in need of contraception. These two rates reflect a range of reasons for discontinuation. Reasons for discontinuation while a woman is in need include: method failure, health concerns or side effects, wanting a more effective method, inconvenience of using a method, lack of access to a method or a method being too far, cost of a method, opposition from a husband, and other context specific reasons. Reasons for discontinuation because a woman is not in need include: wanting to become pregnant, infrequent sex or husband’s absence, marital dissolution/separation, difficulty in getting pregnant/menopause.

These two broad categories of reasons for discontinuation are based on an important distinction for measuring and addressing the phenomenon: discontinuation while in need of contraception suggests that women are at risk of unintended pregnancy, while discontinuation when there is no need for contraception does not carry this risk. Understanding the rates of both types of discontinuation—in addition to the total rate of discontinuation—is critical for developing responses. Though Core Indicator 18a sheds light on the rate and reasons for discontinuation of different methods, it does not provide the full picture of what happens when women stop using contraception. For this we need a complementary indicator which measures the rate at which women switch from one method to another.

Core Indicator 18b estimates the rate at which women stop using one method and begin using another method. This indicator covers two scenarios in which a) a woman stops using one method and immediately begins using another method, or b) a woman stops using one method because she wants a more effective method and begins using a different method after a short period of time (no more than one month). The rate of method switching is reported separately from the rate of discontinuation because method switching is not exclusive of other reasons for discontinuation. For example, if a woman stops using a method because of health concerns or side effects and immediately begins using a different method, this would be counted as one episode of discontinuation and one episode of method switching. By reporting method switching as a different indicator (18b), we avoid double counting in estimates for discontinuation (18a).

Core Indicators 18a and 18b highlight patterns of discontinuation and switching for different methods and can signal potential issues with the provision or use of certain methods (such as lack of counseling, inconsistent method availability, or physical barriers to access). For example, Figure 16 shows that discontinuation rates are consistently higher for short-term methods, including injectables and pills, which have rates as high as 60% and 70% in some countries. Analysis of 28 countries with survey data since 2012 shows average rates of discontinuation while in need that are greater than 20%, meaning that more than a fifth of episodes of use of these methods stopped within 12 months, despite the user still potentially needing contraception. These rates may point to challenges women face in accessing methods that require resupply, may point to their dissatisfaction with these methods, or could be related to side effects, among other possible reasons.

Rates of method switching can provide other insights. A woman may decide to stop using a particular method in favor of one she prefers, or may switch from a less effective short-term method to a more effective long-term method that offers better protection from unintended pregnancy. In these instances, method switching reflects a woman’s right to choose the best option from a range of available methods. Conversely, very low rates of method switching could suggest that women are not able to act on their preferences or that method availability is limited.

In order to understand and effectively address discontinuation, more in-depth analysis is needed on a country and method-specific basis to determine the root causes of this churn in use, whether interventions are needed, and what interventions will have the greatest impact. Core Indicator 18 is a first step toward such an analysis but is insufficient by itself; it must be situated within the broader dynamics of contraceptive use. Discontinuation rates are static, point-in-time estimates, while contraceptive use changes over time as women start, continue, stop, and/or switch methods for different reasons. Additional investments in client-specific longitudinal data collection, monitoring and evaluation can yield better information about discontinuation and the dynamics of contraceptive use—information that can be used to develop and improve programmatic interventions to address discontinuation.

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