Pregnancy resumption following contraceptive discontinuation: Hazard survival analysis of the Indonesia Demographic and Health Survey Data 2007, 2012 and 2017.

Maria Gayatri,Gouranga Dasvarma,Meiwita Budiharsana,Budi Utomo,José Antonio Ortega

doi:10.1371/journal.pone.0264318

Abstract

ObjectiveThe objective of this research is to estimate the probability of pregnancy resumption after discontinuing reversible contraceptives—pills, injectables, implants and IUDs, and to examine the factors associated with the resumption of fertility.MethodThe study uses pregnancy calendar data from Indonesia Demographic and Health Surveys (IDHS) of 2007, 2012 and 2017. A hazard model survival method is used for estimating the time needed to resume pregnancy since discontinuing reversible contraceptives. Retrospective data on 4,573; 5,183 and 5,989 episodes of reversible contraceptive discontinuation at the three surveys respectively have been analysed.ResultsThis study shows that women regained fecundity within one year of discontinuing IUD, pill, injectables or implants. Women using IUD could resume their pregnancy faster than those using implants, pills and injectables. Over the three IDHS 2007, 2012 and 2017 the age-specific percentages of women becoming pregnant after one year of contraceptive discontinuation vary between 72 and 85 for IUD, 75 and 81 for pills, 72 and 76 for implants and 64 and 67 for injectables, with the percentages being higher among younger women. The analysis further shows that length of contraceptive use, parity, prior sexually transmitted infections, knowledge of fertile period, household wealth status and place of residence have no impact on occurrence of pregnancy after contraceptive discontinuation.ConclusionThe analysis disproves a myth that reversible contraceptives make women infertile. Depending on the type of reversible contraceptive used, 65% to 85% of the women were able to conceive after one year of discontinuation.

Highlights

A reversible contraceptive is a method of contraception that makes it possible for a woman to conceive after use of the method has been discontinued [1]
Over the three Indonesia Demographic and Health Surveys (IDHS) 2007, 2012 and 2017 the age-specific percentages of women becoming pregnant after one year of contraceptive discontinuation vary between 72 and 85 for Intrauterine Devices (IUD), 75 and 81 for pills, 72 and 76 for implants and 64 and 67 for injectables, with the percentages being higher among younger women
The analysis further shows that length of contraceptive use, parity, prior sexually transmitted infections, knowledge of fertile period, household wealth status and place of residence have no impact on occurrence of pregnancy after contraceptive discontinuation

Summary

Introduction

A reversible contraceptive is a method of contraception that makes it possible for a woman to conceive after use of the method has been discontinued [1]. The reversible contraceptives studied in this paper are oral contraceptives (pills), injectables, Intrauterine Devices (IUD) and implants, which have a high degree of efficiency to avoid pregnancy during use. Many women have a misconception that a long duration of use of these contraceptives may lead to infertility [4–7] Such misconceptions have a negative impact on the utilisation of modern contraceptive methods in Indonesia and elsewhere [8–12]. A study in Indonesia shows that the myths of oral contraception may dry the vaginal or can harm women’s uterus that leads a delay in conceiving [12]. It is very rare for a woman to use long acting reversible contraception (LARC) before having at least one child. Data collected at the 2007, 2012 and 2017 Indonesia Demographic and Health Surveys (IDHS) show that not even one woman used LARC like IUD or implants before her first pregnancy

Methods

Results

Conclusion