Abstract
Purpose In Egypt, the IUD is the most common contraceptive method since 1988 and has remained so despite a recent drop in its share from 59.9% in 2008 to 51.5% in 2014 in favour of hormonal methods, which increased from 19.7% for pills and 12.3% for injectables in 2008 to 27.4% and 14.5% in 2014 according to 2014 Egypt demographic and health survey (EDHS). The recent shift away from intrauterine contraceptive device (IUDs) to hormonal methods have contributed to increased discontinuation. This paper aims to answer three questions: To what extent does the method type influence the hazard of contraceptive discontinuation in Egypt? Is the interaction between method type and duration of use a predictor of the probability of discontinuation after controlling other variables? What are the other important background variables that affect the hazard of contraceptive discontinuation? Design/methodology/approach Using data from EDHS2014, separate multilevel discrete-time proportional hazard models for events of interest (abandoned use while in need, switched to another method in the month following discontinuation and method failure) were built. Findings Only IUD users are significantly less likely to abandon use while in need and to experience method failure and a reduced risk of switching. During the first 6–10 months of use, all types of discontinuation can be significantly reduced for all three methods. Demographic variables do not significantly affect abandonment but strongly affect switching and significantly affect failure. Socio-economic variables do not significantly affect abandonment and switching. Exposure to media has a significant effect on abandonment but not on switching. Community contraceptive prevalence rate strongly affects switching. Originality/value Results confirm that the counselling should be more intense during the first year of method use and should pay special attention to women who are 25 years old and above and those who have two or more children. Also, media campaigns are important and especially those addressing the issue of abandoning while in need.
Highlights
Contraceptive discontinuation has become a subject of increasing interest, as it is an important determinant of contraceptive prevalence and unwanted fertility (Steele and Curtis, 2003) and, as it may be associated with the quality of family planning programmes (Jain, 1989)
The “abandoned use while in need” status took place for 7.3% and 6.5% of the user segments at the time of the 2008 and 2014 surveys, respectively. These rates amount to 28% and 21.4% of the 12month contraceptive discontinuation rates, respectively (Khalifa et al, 2017)
The analysis shows no significant effect of the age of women, number of living children, place of residence, level of education, woman’s work and wealth index related to contraceptive discontinuation while still in need
Summary
Contraceptive discontinuation has become a subject of increasing interest, as it is an important determinant of contraceptive prevalence and unwanted fertility (Steele and Curtis, 2003) and, as it may be associated with the quality of family planning programmes (Jain, 1989). This has led to the suggestion made by several studies that family planning. Time variant variables Age at intuition of use No of living children. Time invariant variables Education Work status Wealth Media Exposure. Time invariant variables Place of Residence Community CPR. Place of residence (ref: rural upper) Urban governorates Urban lower Rural lower Urban upper Frontiers governorate
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