Using a Chord Diagram to Visualize Dynamics in Contraceptive Use: Bringing Data into Practice.

Amy Finnegan,Megan J Huchko,Saumya S Sao

doi:10.9745/ghsp-d-19-00205

Abstract

We applied a novel approach to visualizing contraceptive histories from the Demographic and Health Surveys (DHS) contraceptive calendar to elucidate patterns of contraceptive switching and discontinuation (e.g., "churn" in contraceptive use across 2 points in time). Taking the contraceptive calendar from the 2014 Kenya DHS, we used R, an open source statistical programming platform, and the chorddiag package to create interactive chord diagrams to visualize contraceptive use trajectories, including switching and discontinuation, for all contraceptive types queried in the DHS. We present screenshots from the interactive version. We also tested the usefulness of our chord diagram with potential users, including family planning researchers and advocates. Chord diagrams are visually appealing and provide users with the ability to investigate unique patterns in contraceptive discontinuation using publicly available data from the DHS. After receiving a brief orientation to a chord diagram, users found the chord diagram easy to understand and manipulate. The chord diagram is a potentially powerful way for family planning researchers, advocates, and program managers to visualize women's contraceptive trajectories and provides insights into the churn in contraceptive use between 2 discrete time periods.

Highlights

In low-income countries, one-third of women who initiate a modern method of contraception discontinue within the first year, and one-half discontinue within the first 2 years, potentially putting them at risk for unintended pregnancies, maternal morbidity, and mortality.[1,2] Dis-continuation rates from hazard models describe the magnitude of the problem, but lack detail on the pathways women take after quitting or switching methods
These event files can be read into R and needs for effective used to create the diagrams we describe in this ar- family planning
We applied chord diagrams to visualize 12-month contraceptive trajectories for women surveyed in the 2014 Kenya Demographic and Health Surveys (DHS) contraceptive calendar

Summary

Introduction

In low-income countries, one-third of women who initiate a modern method of contraception discontinue within the first year, and one-half discontinue within the first 2 years, potentially putting them at risk for unintended pregnancies, maternal morbidity, and mortality.[1,2] Dis-continuation rates from hazard models describe the magnitude of the problem, but lack detail on the pathways women take after quitting or switching methods. A better understanding of the reasons for and patterns in contraceptive discontinuation may help identify intervention points to ensure that women who do not desire pregnancy have access to contraceptive methods that meet their family planning needs. Global Health: Science and Practice 2019 | Volume 7 | Number 4 estimated 38% of women with an unmet need for family planning are former users of contraception.[3] This phenomenon of discontinuers has been labeled the “leaky bucket”4—even when new users begin contraception many of them later quit and total users may decrease. Some level of contraceptive discontinuation is anticipated based on individual preferences, a better understanding of the rates and reasons for discontinuation among women who do not desire pregnancy will help to more effectively address unmet need

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