Contraceptive discontinuation in Egypt as fertility returns to its 2000 level

Abstract

Purpose The similarity of family planning (FP) indicators from EDHS2014 to that of EDHS2000 is alarming for policymakers and researchers who consider it as an echo of the past and a threat, which the FP programme has to face to prevent its progression. In 2000, the total fertility rate (TFR) was 3.5, the contraceptive prevalence rate was 56.1% and the discontinuation rate was 29.5%. In 2014, these indicators were 3.5, 58.5 and 30.1%, respectively. Although the change in the all method discontinuation rate is not large, it is a result of great changes in the method specific discontinuation rates, which was masked by changes in the contraceptive method mix. This study aims to present a comparison between contraceptive discontinuation rates in 2000, 2008 and 2014, discuss the reasons for discontinuation by methods and background characteristics of women and calculate the impact of eliminating discontinuation for reasons related to method and service provision on fertility. Design/methodology/approach Single/multiple decrement life tables were applied to the calendar data of the EDHS2008 and EDHS2014, to examine various net rates of contraceptive discontinuation by reasons and the status after discontinuation. The TFR estimated in the absence of method failure and abandonment while in need of births occurred within 24 months after discontinuation using installed Stata command tfr2. Findings The study estimates the impact of discontinuation on the TFR in 2014 to be an increase of about 20%. The TFR of 3.5 would have been only 2.8 if discontinuation due to method failure and method/service-related reasons were eliminated. Improvement regarding discontinuation behaviour is evident by increased switching, from 43.6 to 54.3% and the drop in the proportion of abandoning use while in need from 56.4 to 45.7%. Differentials suggest that discontinuation is expected to increase among vulnerable groups as desired fertility continues to rise. The increase in the share of “desire to become pregnant” – as a reason for discontinuation is a recent trend observed during the period between EDHS2008 and EDHS2014 and is recognised as a challenge by the national population strategy. Originality/value This study confirms that contraceptive discontinuation is an important part of the overall fertility increase observed by EDHS2014. The rising trend of increased desired family size and the shift away from using the intra uterine device may be considered as major challenges facing the FP programme in Egypt.