Abstract
Introduction. Women who do not switch to alternate methods after contraceptive discontinuation, for reasons other than the desire to get pregnant or not needing it, are at obvious risk for unplanned pregnancies or unwanted births. This paper examines the factors that influence women to switch from Intrauterine Contraceptive Device (IUCD) to other methods instead of terminating contraceptive usage altogether. Methods. The data used for this study comes from a larger cross-sectional survey conducted in nine (9) randomly selected districts of Sindh and Punjab provinces of Pakistan, during January 2011. Using Stata 11.2, we analyzed data on 333 women, who reported the removal of IUCDs due to reasons other than the desire to get pregnant. Results. We found that 39.9% of the women do not switch to another method of contraception within one month after IUCD discontinuation. Use of contraception before IUCD insertion increases the odds for method switching by 2.26 times after removal. Similarly, postremoval follow-up by community health worker doubles (OR = 2.0) the chances of method switching. Compared with women who received free IUCD service (via voucher scheme), the method switching is 2.01 times higher among women who had paid for IUCD insertion. Conclusion. To increase the likelihood of method switching among IUCD discontinuers this study emphasizes the need for postremoval client counseling, follow-up by healthcare provider, improved choices to a wider range of contraceptives for poor clients, and user satisfaction.
Highlights
Women who do not switch to alternate methods after contraceptive discontinuation, for reasons other than the desire to get pregnant or not needing it, are at obvious risk for unplanned pregnancies or unwanted births
62.8% had received Intrauterine Contraceptive Device (IUCD) through vouchers, 76.6% had inserted the multiload, two-thirds were not using any form of contraception prior to IUCD insertion, and three-fourths had experienced method related side effects after IUCD insertion
To promote method switching among IUCD discontinuers, this study emphasizes the need for effective counseling services and follow-up by community health workers
Summary
Women who do not switch to alternate methods after contraceptive discontinuation, for reasons other than the desire to get pregnant or not needing it, are at obvious risk for unplanned pregnancies or unwanted births. Research evidence shows that contraceptive users are less likely to discontinue the method for which they are required to visit a clinic or need assistance from health professionals such as IUCD and implants, compared to discontinuation of short-term or traditional methods [3,4,5,6]. It has been estimated that approximately half of the women that discontinue IUCDs switch to another method within a 3-month period [4] and about 35.6% switch to short-term contraceptive methods. This indicates that those who switch are likely to be highly motivated to restrict fertility whereas others may be intimidated by its side effects, which can be the main reason behind IUCD removal [7]
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