Global Contraceptive Failure Rates: Who Is Most at Risk?

Sarah E.K Bradley,Chelsea B Polis,Akinrinola Bankole,Trevor Croft

doi:10.1111/sifp.12085

Abstract

Contraceptive failure is a major contributor to unintended pregnancy worldwide. DHS retrospective calendars, which are the most widely used data source for estimating contraceptive failure in low‐income countries, vary in quality across countries and surveys. We identified surveys with the most reliable calendar data and analyzed 105,322 episodes of contraceptive use from 15 DHSs conducted between 1992 and 2014. We estimate contraceptive method‐specific 12‐month failure rates. We also examined how failure rates vary by age, education, socioeconomic status, contraceptive intention, residence, and marital status using multilevel piecewise exponential hazard models. Our failure rate estimates are significantly lower than results from the United States and slightly higher than previous studies that included more DHS surveys, including some with lower‐quality data. We estimate age‐specific global contraceptive failure rates and find strong, consistent age patterns with the youngest users experiencing failure rates up to ten times higher than older women for certain methods. Failure also varies by socioeconomic status, with the poorest, and youngest, women at highest risk of experiencing unintended pregnancy due to failure.

Highlights

Contraceptive failure is a major contributor to unintended pregnancy around the world, and represents a gap between women’s and couples’ intentions to avoid pregnancy and their ability to implement those intentions
Recent studies in the United States and France have generally found contraceptive failure rates to decrease as strength of motivation to avoid pregnancy increases, and as socioeconomic status increases
We reviewed known factors associated with contraceptive failure, as described in an analysis of Demographic and Health Survey (DHS) data from 43 countries globally (Polis et al 2016), an analysis using the most recent nationally representative data from the United States (Sundaram et al 2017), and a review of literature on factors associated with contraceptive failure (Black et al 2010)

Summary

Introduction

Contraceptive failure is a major contributor to unintended pregnancy around the world, and represents a gap between women’s and couples’ intentions to avoid pregnancy and their ability to implement those intentions. Elimination of that gap is a goal of policies and programs worldwide (Brown et al 2014; Galati 2015). Despite the programmatic and demographic significance of contraceptive failure, remarkably little is known about its correlates, especially outside of high-income countries. Recent studies in the United States and France have generally found contraceptive failure rates to decrease as strength of motivation to avoid pregnancy increases, and as socioeconomic status increases. Vary by contraceptive method selected (Moreau et al 2007; Kost et al 2008; Black et al 2010). In low- and middle-income settings, two multicountry studies modeled correlates of contraceptive failure using Demographic and Health Survey (DHS)

Methods

Results

Conclusion