REASONS FOR DROP-OUT AMONG CONTRACEPTIVE PILL AND INJECTABLE ACCEPTORS AT A COMPREHENSIVE FAMILY PLANNING CENTER OF A TERTIARY GOVERNMENT HOSPITAL IN THE PHILIPPINES FROM APRIL 1-30, 2025: A QUALITATIVE CROSS-SECTIONAL STUDY

ObjectivesThis study investigated the role of information and communication technology and women’s empowerment in contraceptive discontinuation in Indonesia.MethodsThe study used data from the 2017 Indonesia Demographic and Health Survey and monthly contraceptive calendar data. A Gompertz proportional hazards model was used for analysis.ResultsThe 12-month contraceptive discontinuation rate was higher among women who had used the Internet in the past year, women who were mobile phone owners, and women who reported having fully participated in household decision-making than among their counterparts. These factors significantly impacted the risk of contraceptive discontinuation in Indonesia, even after controlling for contraceptive method, age, parity, contraceptive intent, education, work status, place of residence, and wealth status.ConclusionsAfter adjustment for the control variables, a higher risk of contraceptive discontinuation was associated with having used the Internet in the past year, owning a mobile phone, and not participating in household decision-making. Higher contraceptive discontinuation risk was also associated with using contraceptive pills, older age, lower parity, intent of spacing births, more education, current unemployment, and rural residence, and the risk was also significantly higher for those in the lowest household wealth quintile than for those in the fourth household wealth quintile. The association of contraceptive discontinuation with the use of modern information and communication technology and relatively disempowerment in household decision-making may imply that information regarding family planning and contraception should be conveyed via social media as part of setting up an eHealth system. This must include a strong communication strategy to empower and educate women in contraceptive decision-making.

SummaryBackgroundThe Family Planning 2020 (FP2020) initiative, launched at the 2012 London Summit on Family Planning, aims to enable 120 million additional women to use modern contraceptive methods by 2020 in the world's 69 poorest countries. It will require almost doubling the pre-2012 annual growth rate of modern contraceptive prevalence rates from an estimated 0·7 to 1·4 percentage points to achieve the goal. We examined the post-Summit trends in modern contraceptive prevalence rates in nine settings in eight sub-Saharan African countries (Burkina Faso; Kinshasa, DR Congo; Ethiopia; Ghana; Kenya; Niamey, Niger; Kaduna, Nigeria; Lagos, Nigeria; and Uganda). These settings represent almost 73% of the population of the 18 initial FP2020 commitment countries in the region.MethodsWe used data from 45 rounds of the Performance Monitoring and Accountability 2020 (PMA2020) surveys, which were all undertaken after 2012, to ascertain the trends in modern contraceptive prevalence rates among all women aged 15–49 years and all similarly aged women who were married or cohabitating. The analyses were done at the national level in five countries (Burkina Faso, Ethiopia, Ghana, Kenya, and Uganda) and in selected high populous regions for three countries (DR Congo, Niger, and Nigeria). We included the following as modern contraceptive methods: oral pills, intrauterine devices, injectables, male and female sterilisations, implants, condom, lactational amenorrhea method, vaginal barrier methods, emergency contraception, and standard days method. We fitted design-based linear and quadratic logistic regression models and estimated the annual rate of changes in modern contraceptive prevalence rates for each country setting from the average marginal effects of the fitted models (expressed in absolute percentage points). Additionally, we did a random-effects meta-analysis to summarise the overall results for the PMA2020 countries.FindingsThe annual rates of changes in modern contraceptive prevalence rates among all women of reproductive age (15–49 years) varied from as low as 0·77 percentage points (95% CI −0·73 to 2·28) in Lagos, Nigeria, to 3·64 percentage points (2·81 to 4·47) in Ghana, according to the quadratic model. The rate of change was also high (>1·4 percentage points) in Burkina Faso, Kinshasa (DR Congo), Kaduna (Nigeria), and Uganda. Although contraceptive use was rising rapidly in Ethiopia during the pre-Summit period, our results suggested that the yearly growth rate stalled recently (0·92 percentage points, 95% CI −0·23 to 2·07) according to the linear model. From the meta-analysis, the overall weighted average annual rate of change in modern contraceptive prevalence rates in all women across all nine settings was 1·92 percentage points (95% CI 1·14 to 2·70). Among married or cohabitating women, the annual rates of change were higher in most settings, and the overall weighted average was 2·25 percentage points (95% CI 1·37–3·13).InterpretationsOverall, the annual growth rates exceeded the 1·4 percentage points needed to achieve the FP2020 goal of 120 million additional users of modern contraceptives by 2020 in the select study settings. Local programme experiences can be studied for lessons to be shared with other countries aiming to respond to unmet demands for family planning. The findings of this study have implications for the way progress is tracked toward achieving the FP2020 goal.FundingThe Bill & Melinda Gates Foundation.

Contraceptive discontinuation and switching behaviour of a couple has significant influence on fertility in Bangladesh in spite of a successful national family planning programme. This study examines the determinants of contraceptive use, discontinuation and switching behaviour by using calendar data extracted from 2004 Bangladesh Demographic and Health Survey. Life table and multiple-decrement life table techniques are used to find out the contraceptive discontinuation rates and method specific discontinuation rates. The study shows that contraceptive prevalence increases with education, socioeconomic status, intention status, residence, age, parity and whether a family planning worker visited the home. Almost half of women who initiate the use of a method discontinue use within a year and nearly two-thirds discontinue within two years. The IUD has the lowest discontinuation rates, whereas the condom, followed by the injectable and oral contraceptive pill, have the highest rates. The findings indicate that side effects are the major cause of discontinuation for the pill, IUD and injectables. Determinants of switching behaviour are analyzed to identify users in need of contraception as well as those who abandoned use and would like to continue using contraception. Findings encompass the whole process of contraceptive use as well as women’s experience and difficulties in continuation of contraceptive use. Kaushalendra KUMAR SINGH, Professor, Department of Statistic, Banaras Hindu University, Varanasi – 221 005, India, E-mail: kksingh@bhu.ac.in . Tapan KUMAR ROY, Research Scholar, Department of Statistic, Banaras Hindu University, Varanasi – 221 005, India. E-mail: roy.tapan@gmail.com . Brijesh PRATAP SING, Assistant Professor, Faculty of Commerce, Banaras Hindu University, Varanasi – 221 005, India. E-mail: brijesh@bhu.ac.in . DOI: 10.4402/genus-157

Although the extent to which organized family planning programs influence reproductive preferences remains a subject of debate, most observers would grant that such programs play a key role in helping individuals to realize their contraceptive and reproductive intentions. However, few prior studies have quantified the magnitude of this facilitating or enabling effect of family planning services, given existing demand for contraception. This study takes advantage of panel survey data and linked information on the supply environment for family planning services in Morocco in order to bridge this research gap. In the analysis, contraceptive use during the 1992-95 period is related to contraceptive intentions in 1992; individual-, household-, and community-level determinants of contraceptive behavior; and family planning supply factors. Estimation procedures are used that control for unobserved joint determinants of contraceptive intentions and use. Evidence of a significant enabling or facilitating role of family planning services is found, and the results also suggest that family planning program factors influence contraceptive intentions in important ways.

Pakistan’s government has a decades-old commitment to family planning, but the population indicators show that the progress is far from ideal. The modern contraceptive prevalence rate has been at 24% for a decade while the unmet need for family planning is quite high at 17 percent (1). Population researchers and experts are working to understand the reasons behind this slow and inconsistent progress. One significant yet less discussed factor is the non-inclusion of young people in family planning. Pakistan is currently going through a demographic transition; a significant portion of its population, approximately 60 percent, is below the age of 30 (2). Modern contraceptive prevalence rate drops to six percent for married girls aged 15-19 and 13 percent for married women aged 20-24 years (1). These findings indicate that young people are far behind in their access to family planning information and services. It is imperative for the population sector policymakers to come up with well-structured youth-inclusive family planning programs to ensure that the country has the full support of this crucial segment of its population. Thus far youth has not received the due attention in policy and practice around family planning even though they represent the largest segment population of Pakistan, they have never received the proportionate attention regarding their sexual and reproductive health (SRH), including information and access to family planning. They come across significant sexual and reproductive health challenges such as limited or no access to necessary information, stigma related to contraceptives use, and a lack of youth-friendly health information and services (3). The conservative culture and traditional taboos around sexuality, and sexual and reproductive health of youth in Pakistan contributes to creating barriers to awareness and service delivery, which consequently results in low modern contraceptive prevalence rate amongst youth (4).

Countries in Latin America and the Caribbean (LAC) have substantially improved access to family planning over the past 50 years. Many have also recently adopted explicit declarations of universal rights to health and universal health coverage (UHC) and have begun implementing UHC-oriented health financing schemes. These schemes will have important implications for the sustainability and further growth of family planning programs throughout the region. We examined the status of contraceptive methods in major health delivery and financing schemes in 9 LAC countries. Using a set of 37 indicators on family planning coverage, family planning financing, health financing, and family planning inclusion in UHC-oriented schemes, we conducted a desk review of secondary sources, including population surveys, health financing assessments, insurance enrollment reports, and unit cost estimates, and interviewed in-country experts.Findings: Although the modern contraceptive prevalence rate (mCPR) has continued to increase in the majority of LAC countries, substantial disparities in access for marginalized groups remain. On average, mCPR is 20% lower among indigenous women than the general population, 5% lower among uninsured women than insured, and 7% lower among the poorest women than the wealthiest. Among the poorest quintile of women, insured women had an mCPR 16.5 percentage points higher than that of uninsured women, suggesting that expansion of insurance coverage is associated with increased family planning access and use. In the high- and upper-middle-income countries we reviewed, all modern contraceptive methods are typically available through the social health insurance schemes that cover a majority of the population. However, in low- and lower-middle-income countries, despite free provision of most family planning services in public health facilities, stock-outs and implicit rationing present substantial barriers that prevent clients from accessing their preferred method or force them to pay out of pocket. Leveraging UHC-oriented schemes to sustain and further increase family planning progress will require that governments take deliberate steps to (1) target poor and informal sector populations, (2) include family planning in benefits packages, (3) ensure sufficient financing for family planning, and (4) reduce nonfinancial barriers to access. Through these steps, countries can increase financial protection for family planning and better ensure the right to health of poor and marginalized populations.

Momentum for family planning in the Democratic Republic of the Congo (DRC) is evident in multiple ways: strong political will, increasing donor support, a growing number of implementing organizations, innovative family planning programming, and a cohesive family planning stakeholder group. Between 2013 and 2017, the modern contraceptive prevalence rate (mCPR) in the capital city of Kinshasa increased from 18.5% to 26.7% among married women, but as of 2013-14, it was only 7.8% at the national level. The National Multisectoral Strategic Plan for Family Planning: 2014-2020 calls for achieving an mCPR of 19.0% by 2020, an ambitious goal in light of formidable challenges to family planning in the DRC. Of the 16,465 health facilities reporting to the national health information system in 2017, only 40% offer family planning services. Key challenges include uncertainty over the political situation, difficulties of ensuring access to family planning services in a vast country with a weak transportation infrastructure, funding shortfalls for procuring adequate quantities of contraceptives, weak contraceptive logistics and supply chain management, strong cultural norms that favor large families, and low capacity of the population to pay for contraceptive services. This article describes promising initiatives designed to address these barriers, consistent with the World Health Organization's framework for health systems strengthening. For example, the national family planning coordinating mechanism is being replicated at the provincial level to oversee the expansion of family planning service delivery. Promising initiatives are being implemented to improve the supply and quality of services and generate demand for family planning, including social marketing of subsidized contraceptives at both traditional and non-traditional channels and strengthening of services in military health facilities. To expand contraceptive access, family planning is being institutionalized in nursing schools, allowing students to operate as community-based distributors. While major challenges remain, significant progress in family planning has been made in the DRC, which should be judged not in comparison with sub-Saharan African countries with high mCPR and mature programs, but rather with those starting from much further behind.

IntroductionUganda currently hosts an estimated 1.5 million refugees. The refugees have challenges in accessing family planning (FP) services in the host country. The study aimed to investigate factors associated with FP use among host and refugee populations in Adjumani district, Uganda.MethodsA comparative cross-sectional study was conducted in May 2021 in three refugee settlements and their host communities in Adjumani district. A total of 1,310 respondents, (664 refugees and 646 host) were randomly selected using multistage cluster sampling and interviewed. Quantitative data were collected using structured questionnaires and analyzed using STATA V.15. Descriptive and Multivariate analysis performed.ResultsWe found that modern Contraceptive Prevalence Rate (mCPR) was 30.2% (32.2% for host and 28.2% for refugees). Multivariate analysis showed that women who live singly (AOR = 2.25, 95%, CI: 1.56 -3.84), completed primary education [AOR = 1.65, 95% CI: 1.27–2.16], acquired skills [AOR = 2.28, 95% CI: 2.11–2.47], have the desire for another child [AOR = 3.73, 95% CI: 1.45- 9.60], have stayed in the study area between 3–5 years [AOR = 2.24, 95% CI: 1.46–3.42] were statistically significantly associated with FP use among both refugee and host populations. The key barrier to FP use by host was harassment of women and separation/divorce for not consulting the family members. Whereas amongst the refugees, they do not want to use FP methods.ConclusionOur findings revealed low FP use amongst both populations in Adjumani district. The main factors associated with FP use amongst refugee populations included marital status, level of education, type of occupation, and duration of stay in the study area whereas amongst the host is the marital status. Main reasons for not using FP methods included fear of side effects by hosts and not wanting to use FP by refugees. There is need to sensitize both communities about the benefits of FP at community level.

This study primarily aimed to evaluate the status of modern Family Planning Program (mCPR) in the Province of Lanao del Sur based on national objective to increase modern Contraceptive Prevalence Rate (mCPR) among all women from 24.9% in 2017 to 30% by 2022. More specifically, it attempts to answer the following research questions: how many numbers of family planning counselling were given to the clients from 2011-2018; what is the percentage status of modern Contraceptive Prevalence Rate (mCPR) from 2011-2018; and if family planning counselling given can significantly predict modern Contraceptive Prevalence Rate from 2011-2018. Descriptive and evaluative research design using quantitative approach in the interpretation of data was employed in this study. Data that was used in this study was taken from the annual reports of Integrated Provincial Health Office in Lanao del Sur, Philippines from 2010 – 2018 through data mining process, after taking the formal consent from the appropriate responsible authority. The data was then subjected to multiple linear regression analysis through SPSS software to test the research hypothesis. Results revealed that family planning counselling given to the clients was statistically significant in predicting the modern Contraceptive Prevalence Rate from 2011-2018 in Lanao del Sur, Philippines. Hence, strengthening of the family planning counselling program should be one of the top priorities of family planning program in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM) provinces to increase the coverage number of acceptors especially on Modern Contraceptive Methods of Family Planning.

BackgroundMalawi has made progress in increasing its overall modern contraceptive prevalence rate since 2000, resulting in a dramatic reduction in its total fertility rate. However, youth, 15–24 years, have not had the same successes. Teenage pregnancies are on the rise and little progress has been made in reducing unmet need for family planning among youth. With two-thirds of the population under the age of 25 and with Malawi’s rapid population growth, reducing unmet need for family planning among youth remains a priority for the government’s reproductive health agenda. To further explore this situation, we conducted a qualitative study to explore the perspectives of youth and adults about the drivers and barriers to youth accessing family planning in Malawi and their ideas to improve services.MethodsWe conducted 34 focus group discussions with youth aged 15–24 and parents or legal guardians of female youth in 3 districts in Malawi. Focus groups were translated and transcribed. Data was input into Dedoose and analyzed using a thematic framework to identify broader patterns and themes.ResultsYouth participants felt motivated to use family planning to protect themselves from sexually transmitted diseases and to prevent unwanted pregnancies. Females focused on the consequences of unplanned pregnancies and believed family planning services were targeted primarily at them, while males thought family planning services targeted males and females equally. Barriers to youth accessing family planning included contraception misconceptions, the costs of family planning services, and negative attitudes. Parents had mixed views on family planning. While many parents acknowledged they could play a role in supporting youth, most said they are reluctant to support youth using family planning. Participants said improving counseling services, integrating family planning services and education within school curricula, and utilizing youth clubs could improve family planning services for youth.ConclusionsPolicy makers and program implementers should consider the diverse preferences among youth and parents and continue seeking their input when designing policies and programs. Youth clubs and school-based services were among the most common suggestions. However, the effectiveness of youth clubs and school-based initiatives to increase contraceptive use among youth in Malawi is not clear.

Kenya has made significant strides in family planning (FP), exceeding its FP2020 commitment with a 61% modern contraceptive prevalence rate (mCPR) nationally.1 However, substantial regional disparities persist, particularly in underserved counties like Wajir, Mandera, Marsabit, Garissa, and Isiolo, where mCPR can be as low as 2%.1 These regions face complex barriers including entrenched socio-cultural norms, a strong desire for large families, patriarchal decision-making, high poverty, illiteracy, and faith-motivated opposition often stemming from misinterpretations of religious texts. Service delivery is further hampered by limited coverage, long distances to facilities, and insufficient trained personnel. Recognizing the profound influence of religious leaders as trusted community figures, Faith to Action Network (F2AN) implemented an interfaith, client-centered FP program across nine Kenyan counties from 2020-2023. This innovative approach partnered with diverse faith organizations (Muslim, Christian, Indigenous Christian) to address religious and cultural barriers. F2AN engaged 248 Faith Leaders through values clarification workshops, scriptural re-interpretation led by theologians, and FP training to dispel myths and foster positive attitudes. The program integrated faith-based Social Behavior Change and Communication (SBCC) strategies, including community dialogues, male engagement sessions, and radio broadcasts, providing scriptural backing for child spacing. Program results demonstrate significant impact: improved FP referral completion rates (e.g., Isiolo County from 75% to 87%), increased male acceptance and support for FP, and widespread awareness through faith platforms. Overall, the program reached 192,809 Women of Reproductive Age, including 20,748 adolescents and youth, and 850 persons with disabilities, providing 210,156 FP methods.2 This case study confirms the strategic role of interfaith organizations in mobilizing religious leaders to promote effective FP. The interfaith approach, by clarifying scripture and fostering a united front, offers a cost-effective, replicable, and scalable model for enhancing FP uptake in rural and underserved areas. It underscores the importance of incorporating faith and cultural leaders into national and county-level health planning structures to ensure culturally sensitive and effective service delivery.

Nowadays there are multiple types of contraceptive methods, from reversible to permanent, for those choosing to delay pregnancy. Misconceptions about contraception and infertility are a key factor for discontinuation or the uptake of family planning methods. Regaining fertility (the ability to conceive) after contraceptive discontinuation is therefore pivotal. Technical studies to date have evaluated return to fertility by assessing pregnancy as an outcome, with variable results, or return to ovulation as a surrogate measure by assessing hormone levels (such as progesterone, LH, FSH) with or without transvaginal ultrasound. In general, relying on time to pregnancy as an indicator of return to fertility following contraceptive method discontinuation can be problematic due to variable factors independent of contraceptive effects on fertility, hormone clearance, and fertility recovery. Since the ability to conceive after contraceptive method discontinuation is a critical factor influencing product uptake, it is important to have robust biomarkers that easily and accurately predict the timing of fertility return following contraception and isolate that recovery from extrinsic and circumstantial factors. The main aim of this review is to summarize the current approaches, existing knowledge, and gaps in methods of evaluating return-to-fertility as well as to provide insights into the potential of new biomarkers to more accurately predict fertility restoration after contraceptive discontinuation. Biomarker candidates proposed in this document include those associated with folliculogenesis, cumulus cell expansion, follicular rupture and ovulation, and endometrial transport and receptivity which have been selected and scored on predefined criteria meant to evaluate their probable viability for advancement. The review also describes limitations, regulatory requirements, and a potential path to clinically testing these selected biomarkers. It is important to understand fertility restoration after contraceptive method discontinuation to provide users and health providers with accurate evidence-based information. Predictive biomarkers, if easy and low-cost, have the potential to enable robust evaluation of RTF, and provide potential users the information they desire when selecting a contraceptive method. This could lead to expanded uptake and continuation of modern contraception and inform the development of new contraceptive methods to widen user's family planning choices.

Increased use of contraceptives in Malawi has not translated into a commensurate reduction in fertility, but the reason is unknown. Insight into contraceptive switching and discontinuation may shed light on this conundrum and on whether the commonly used modern contraceptive prevalence rate (mCPR) is the best indicator of family planning program performance. A one-year prospective longitudinal data set was created from patient-held family planning cards of 4,678 reproductive-age women living in a demographic surveillance site in rural northern Malawi. Contraceptive service data recorded on the women's cards by providers were linked to their socioeconomic, demographic and health data. Contraceptive point prevalence estimates calculated from these data were compared with mCPR estimates from cross-sectional surveys. Survival analyses examined contraceptive adherence. The contraceptive point prevalence of 35% was slightly lower than comparable cross-sectional estimates of mCPR. Only 51% of users of the injectable-the most widely used modern method-received their first reinjection on time, and just 15% adhered to the method for 12 months. Although various study variables were associated with contraceptive use, none were associated with adherence. Gaps in and discontinuation of use of the injectable may play a role in the discrepancy between mCPR and fertility. Interventions to help women adhere to injectable use and to promote long-acting methods should be strengthened.

Despite greater availability and affordability of modern contraception, the use of traditional contraception is rising in India. We examined the relationship between Indian women's contact with a community health worker (CHW) and discussion of family planning (FP) with their contraceptive use. We analyzed data from 306,037 nonpregnant, non-sterilized married women in the 2019-2021 National Family Health Survey (NFHS). Multinomial regression models estimated the association between CHW contact and contraceptive use (consistent use, switching, and discontinuation) in the past three months. Nearly 22 percent of women reported current use of traditional contraception, with 18 percent reporting exclusive use and 4.1 percent concurrent method use. Traditional contraception was more common among older women, women with lower education, higher parity, and in nuclear households. CHW discussion on FP was associated with higher traditional contraceptive use [Adjusted Odds Ratio (AOR) = 1.11 (95 percent Confidence Interval (CI): 1.04, 1.19)], reversible modern method use [AOR = 1.92 (95 percent CI: 1.82, 2.02)], and concurrent use [AOR = 2.19 (95 percent CI: 1.95, 2.45)]. Recent CHW engagement was associated with consistent modern method use [Adjusted Relative Risk Ratio (ARRR)= 2.02 (95 percent CI: 1.91, 2.13)], switching from traditional to modern method [ARRR = 1.67 (95 percent CI: 1.14, 2.46)], and discontinuation of modern contraception [ARRR = 2.10 (95 percent CI: 1.81, 2.44)]. CHW engagement on FP may enable initiation and consistent use of traditional and modern methods, switching, and discontinuation of contraception.

<p><strong>Background</strong>: Improving access to family planning in the Pacific region has been slow, especially for those living in remote and rural areas. Pacific countries consistently report contraceptive prevalence rates well below the United Nations’ global averages for ‘less developed’ regions. The most recent data available on family planning usage in Kiribati from 2009 reported that the modern contraceptive prevalence rate was just 18.0% and total contraceptive prevalence rate just 22.3%.</p><div><p>The aim of the study was to investigate knowledge and use of family planning and identify barriers to contraceptive uptake for men and women of reproductive age in South Tarawa, Kiribati, to inform future approaches aimed at increasing access to family planning.</p><p><strong>Methods:</strong> A mixed methods approach was used. A community survey of men and women of reproductive age (15-49 years) (n=500) was carried out to identify current levels of knowledge, contraceptive use and barriers to use. Focus groups (n=4) of target populations (men 15-24, men 25-49, women 15-24, women 25-49) were undertaken and in-depth interviews (n=14) were conducted with health professionals and government officials to interpret survey results, further investigate barriers and generate ideas for improving service delivery.</p><p><strong>Findings:</strong> Considerable barriers to family planning use were observed in the community survey and explored in the interviews and focus groups. They can be categorised into four thematic groups: disinterest in family planning; knowledge gaps; personal, family and social objections; and unsuitable service delivery.<strong><em></em></strong></p></div><p><strong>Conclusion:</strong> A broad range of solutions were identified and fourteen service delivery recommendations were made for family planning service providers in South Tarawa. The recommendations may also hold relevance to other Pacific countries, however we encourage service providers to consider their country context before initiating any recommendations provided in this study. </p>