Contraceptive Discontinuation Research Articles

Risk of Discontinuance in Contraceptive Uptake Among Kenya Women: A Survival Analysis Using the Cox Proportional Hazard Model

A problem of equal importance is the substantial challenge posed by the discontinuance of contraceptive use in family planning programs, particularly for developing countries such as Kenya. Investigating the determinants of contraceptive discontinuation using demographic factors can provide insights to enhance the efficacy of family planning. Using data from the Performance Monitoring for Action (PMA) survey, this study examined the demographic and contraceptive method-related covariates associated with the risk of discontinuation of contraception among Kenyan women. The study employed Cox proportional hazards models to analyze sampled data of Kenyan women from the PMA survey. Two separate models were used: a standard model which included demographic characteristics with a baseline contraceptive variable (Ever use contraceptive) and an extended model showing how specific contraceptive methods impact the likelihood of the risk of discontinuing contraception. Older age (Coefficient of -0.268 with a hazard ratio of 0.765) was associated with a decreased risk of contraceptive discontinuation. At the same time, women with higher educational levels (Coefficient of 0.015, with a hazard ratio of 1.015) were related to an elevated hazard and were more likely to discontinue their current method of contraception. The extended model showed that subcutaneous injectable contraceptives (Coefficient of -2.040 with a hazard ratio of 0.130) and male condoms (Coefficient of -1.137 with a hazard ratio of 0.321) were conditionally related to a significantly decreased hazard of discontinuation. The results highlight the importance of contraception choice and the significance of age and education in maintaining continuous contraception. To support Kenyan women in maintaining continuous contraception in achieving their reproductive health goals comprehensive education on emergency contraception and the provision of long-acting reversible contraceptives should be provided by health and family planning organizations. There is a call for a longitudinal study to offer an understanding of the dynamic behavior of contraception over time and the need for time-varying analyses to capture the evolving nature of contraception and its discontinuation.

Counseling Women About Sexual Health Effects of Contraceptives.

Background: Choosing a contraceptive method is a pivotal decision for patients, whereas health care professionals (HCPs) face challenges in providing suitable recommendations. Adverse sexual effects often lead to dissatisfaction and discontinuation of contraceptives, underscoring the importance of thorough counseling and shared decision making between HCPs and patients. Objective: This article aims to investigate the relationship between contraceptive methods and female sexual function through a comprehensive review of available literature, emphasizing the importance of considering sexual health in contraceptive prescription and management. Methods: A systematic analysis of existing literature, incorporating studies utilizing validated sexual health questionnaires, was conducted to elucidate the intricate interplay between contraceptives and female sexual function. Results: The review encompasses various contraceptive methods, including combined hormonal contraceptives, progestin-only pills, depot medroxyprogesterone acetate, subdermal contraceptive implants, hormonal intrauterine devices, permanent sterilization, and barrier methods. Insights gleaned from the analysis shed light on the impact of these methods on female sexual health. Conclusion: Comprehensive understanding of the effects of contraceptives on female sexual function is crucial for both HCPs and patients. By integrating sexual health considerations into contraceptive surveillance, compliance can be improved, contraceptive efficacy optimized, and the risk of unwanted pregnancies minimized. This review underscores the significance of tailored counseling and shared decision making in contraceptive management, particularly for cisgender women.

Reasons for contraceptive discontinuation among women of reproductive age in Kano, Nigeria: A qualitative study

Women’s attempts to achieve their desired levels of fertility are hindered when they stop using contraceptives, which could lead to unwanted pregnancies. This study aimed to assess reasons for contraceptive discontinuation among women of reproductive age in urban and rural areas of Kano State, Nigeria. Qualitative data were collected in urban and rural communities of Kano State in February to May, 2022 from women of reproductive age group, their male partners, family planning service providers, and community and religious leaders. Focus group discussions (FGD), and key informant interviews (KII), using multi-stage sampling methods explored previous experience with contraceptive use, fertility consequences and reasons for contraceptive discontinuation. Following data collection, digitally recorded data were transcribed verbatim, translated, and coded using thematic analysis through an inductive approach. Study reported the high discontinuation rates and identified side effects as the primary reason for discontinuation, with injectable contraceptives being the most commonly discontinued method. Other reported reasons for contraceptive discontinuation by respondents in both urban and rural groups were: method failure, intention to get pregnant, health concerns, husband disapproval, methods not available, inconvenience to use and interference with body structure or functions. The high contraceptive discontinuation poses significant risks of unintended pregnancies and unsafe abortions, thereby increasing maternal morbidity and mortality rates in Kano State. These consequences emphasize the need for family planning interventions that incorporate quality of care in service provision to address contraceptive discontinuation. Engaging men and other social influencers in family planning programs and services will help gather support for contraception, rather than focusing exclusively on women.

Discontinuation of long-acting reversible contraception: a retrospective Dutch study in general practice

Background In the Netherlands, the use of long-acting reversible contraception (LARC) methods increases. Studies show high premature discontinuation rates of LARCs, but comprehensive insights into the Dutch situation remain limited. Aim The aim of this study is to determine (1) the rate and reasons of discontinuation of different types of LARC in the first 2.5 years of use and (2) what patient characteristics are associated with premature discontinuation. Design and setting Retrospective cohort study utilising data from a Dutch primary care research network. Methods We included all women who received a LARC between 2017 and 2019 with a 2.5-year follow-up period. We performed a descriptive analysis, Kaplan Meier and logistic regression analysis to answer the research questions. Results We included 642 women. In total, 166 women (25.9%) discontinued their LARC within 2.5 years. Discontinuation rates were 22% for levonorgestrel intra-uterine systems (LNG-IUS) 52 mg, 25% for LNG-IUS 19.5 mg, 39% for copper IUDs and 47% for subdermal implants. Common reasons for discontinuation were: alterations in bleeding pattern (68%), abdominal pain (32%), headache or mood fluctuation (24%) and a preference for natural contraceptive methods (23%). Factors associated with discontinuation for reasons other than pregnancy wish were: age between 30 and 34 years old (OR 5.1, 95% CI [1.26–20.48]) and a history of sexual, physical and/or psychological abuse (OR 3.16, 95% CI [1.60–6.23]). A high educational level (OR 0.33, 95% CI [0.12–0.89]) was associated with a lower risk of discontinuation. Conclusion The discontinuation rates of LARCs are high. Better counselling might prevent premature discontinuation.

Bone density changes in young women in Uganda using tenofovir-based HIV pre-exposure prophylaxis and depot medroxyprogesterone acetate contraception

Background: Injectable depot medroxyprogesterone acetate (DMPA) is the most common contraceptive choice among young women in Uganda, where HIV burden is high and HIV pre-exposure prophylaxis (PrEP) may be offered. For young women who choose to use both agents concurrently, it is unknown whether they will experience declines in BMD beyond those elicited by either product singly. Methods: From 2018–2022, we conducted a 2-year prospective study with women ages 16–25 years in Kampala, Uganda desiring pregnancy and HIV prevention. Women were provided condoms, injectable DMPA, and/or FTC/TDF, according to their choices and underwent annual dual x-ray absorptiometry (DXA) scans. We used tenofovir-diphosphate (TFV-DP) quantification in dried blood spots and DMPA injection dates to classify exposure. Linear regression models estimated the difference in % BMD change from baseline to month 12 for women using FTC/TDF and DMPA versus women using neither product. Results: Of 499 enrolled women, discontinuation and re-starting of contraception and PrEP was common. Women consistently using neither product (n = 39) experienced BMD increases. Women with consistent use of both products during 1 year (n = 22) experienced an average BMD loss of 1.04% at lumbar spine and hip and 1.77% at femoral neck. These losses were different relative to women who used neither agent: lumbar spine -3.35% (95% CI −5.13%, −1.56%, p = 0.001), total hip −2.24% (95% CI −3.87%, −0.60%, p = 0.009), and femoral neck −1.71% (95% CI −3.73%, 0.31%, p = 0.102). Conclusion: We observed a trend for women with concurrent DMPA and FTC/TDF PrEP use to have 1–3% lower BMD than unexposed women after 12 months.

The Effect of Social Media Influencer Warranting Cues on Intentions to Use Non-Hormonal Contraception

ABSTRACT Young women increasingly get sexual health information from social media influencers, who use persuasive communication and can alter attitudes, intentions, and behaviors. Contraception is a commonly discussed health topic among influencers on social media. Previous research suggests that influencers negatively frame and encourage the discontinuation of hormonal contraception. At the same time, influencers also encourage the uptake of less effective non-hormonal options, such as fertility awareness-based methods. Though descriptive content analysis work details these patterns in influencer contraceptive messaging, there is no experimental research that explains message effects. The purpose of this study was to experimentally test the effect of influencer contraceptive-related messaging on behavioral health intentions. This study introduces warranting theory as a potentially valuable model for explaining online health communication message effects. Specifically, this study tested the effect of influencer messages containing sponsorship and medical disclaimers on intentions to use non-hormonal contraception. U.S. females (n = 296) ranging in age from 18–29 years old participated in a survey. Findings suggest that the interaction led to decreased intentions to use non-hormonal contraception. However, findings did not support a relationship between influencer messaging and impressions, which highlights potential boundary conditions for warranting theory and high-risk health behaviors. Additionally, there was a positive relationship between perceived trustworthiness and expertise of the influencer and intention to use non-hormonal contraception. Future research should test influencer messaging using real social media content and consider the effect of parasocial relationships. Practical implications highlight the need for comprehensive contraceptive counseling.

The Reliability of Contraceptive Discontinuation Reporting in Burkina Faso, Kenya, and Uganda.

Family planning researchers have been studying the discontinuation of contraception-the prevalence and reasons for it-for decades, as it has implications for contraceptive prevalence, total fertility, and unintended fertility. However little is known about the reliability of contraceptive discontinuation reporting: only two studies have examined the reliability of reported discontinuation in low-resource contexts. We use longitudinal and overlapping data from reproductive calendars to test the reliability of women's reporting of contraceptive discontinuation in Burkina Faso, Kenya, and Uganda. We test whether recent discontinuations reported at baseline are reported one year later, and if the same reason for discontinuation is reported. Results reveal moderate reliability at the aggregate level of reporting of the index discontinuation; however, reliability is low when the timing of discontinuation is considered. There is variability across the reliability of reasons for discontinuation; discontinuation due to desired pregnancy is reported reliably while other reasons are less reliably reported. Our findings have important implications for the field, particularly in how the data are used and interpreted; we urge caution around event-level analyses of contraceptive discontinuation and reasons for discontinuation, given low reliability.

Social Determinants of Health and Patient-Reported Difficult Discontinuation of Long-Acting Reversible Contraception.

Background: Some individuals who receive long-acting reversible contraception (LARC) face barriers to discontinuation. The inability to discontinue a contraceptive method when desired negatively impacts a person's reproductive autonomy. Persons impacted by social determinants of health (SDH) may be disproportionately affected. The objective of this study is to evaluate the association of SDH with patient-reported difficult LARC discontinuation. Methods: A retrospective cross-sectional analysis of data from the 2017-2019 cycle of the National Survey of Family Growth was conducted. The main outcome was patient-reported difficulty discontinuing a LARC method (intrauterine device or implant) in the last 10 years. Descriptive statistics were used to identify demographic characteristics and SDH domains. Multivariable logistic regression models were used to estimate associations across SDH domains with difficult LARC removal. Results: A total of 754 respondents reported wanting to have their LARC removed, and 105 (11%) reported difficulty discontinuing LARC methods. One-third of respondents experienced one or more SDH, notably food insecurity (26%) or transportation barriers (30%). After adjusting for age, race, education, geographic location, parity, and body mass index (BMI), persons with one or more SDH had an increased adjusted odds ratio (aOR) for difficultly discontinuing LARCs compared with respondents without any SDH (2.11; 95% confidence interval [CI]: 1.21, 3.69). Transportation barriers demonstrated the largest aOR of 2.90 (95% CI: 1.07, 7.87). Conclusions: SDH are associated with challenges to LARC discontinuation. SDH are unique risk factors that can impact one's entire contraceptive experience. A nuanced discussion of SDH at the time of contraceptive counseling may be a critical step in addressing the intersectionality of method selection and reproductive agency.

Low Usage of Modern Contraceptives Among Women of Reproductive Age in Tanzania: Analysis Beyond Availability and Awareness Factors

Most studies on contraceptives have linked low use with awareness and problems of availability. However, these studies have not considered low or discontinuation of use of contraceptives to be a positive phenomenon where women exercise their reproductive rights or autonomy. Hence, this article has adopted a Marxist-Feminist theory of contraceptives to examine the association between socio-demographic factors and low usage of contraceptives among women of reproductive age. It also evaluates the influence of the availability and awareness on the use or non-use of contraceptives among such a group of women. The article is based on a cross- sectional case study conducted in Kigoma Rural District, Tanzania. The data were collected through questionnaires modified from TDHS, interviews with nurses, and an in-charge of a health facility. Secondary data were collected from TDHS (2016, 2022), Tanzania Service Delivery Point report, Stock Inventory Charts and Our World data sets. Quantitative analysis was performed through STATA 14, and secondary data was processed through content analysis. The study found that though the majority of the reproductive age are aware of contraceptives, most (80%) have not used them. We do not treat this as a problem, but an exercise of reproductive rights and autonomy by women. In addition, there is no significant evidence to prove any influence of socio-demographic factors on low use of contraceptives. Low use and discontinuation of contraceptives are associated with the need for more children by women, and the side effects of contraceptives. Therefore, we conclude that women should be left to decide when and how to use contraceptives: they should not be forced through direct or indirect health services.

YouTube and the implementation and discontinuation of the oral contraceptive pill: A mixed-method content analysis.

Women living in high-quality healthcare systems are more likely to use oral contraceptives at some point in their lives. Research findings have sparked controversial discussions about contraception in the scientific community and the media, potentially leading to higher rates of method discontinuation. Understanding the underlying motives for method discontinuation is crucial for reproductive health equity and future programming interventions. To address this question, this study aims to explore women's experiences of oral contraceptive use and discontinuation on YouTube. A concurrent explanatory mixed-methods design was used to conduct content analysis of German YouTube videos. The information from 175 videos of 158 individuals was extracted through quantitative descriptive content analysis. Twenty-one individuals were included in the qualitative content analysis. The body was a recurring theme in the pill biographies. Women described, for example, bodily sensations as reasons for taking and stopping the pill. They also described positive and negative side effects while taking the pill and after stopping. The most common side effects of taking the pill mentioned by YouTubers were mood swings (76/158), weight gain (45/158), headaches (33/158), and depressed mood (45/158). The symptoms after discontinuation reported most were facial skin impurities (108/158), decreased mood swings (47/158), hair loss (42/158), and weight loss (36/158). Overall, women overwhelmingly rated their discontinuation experience as positive (87/91). The study identified key symptoms of oral contraceptive initiation and discontinuation by portraying the experiences of female YouTubers, adding valuable insights to the understanding of method initiation and discontinuation. Further research is needed to explore women's personal experiences with method discontinuation beyond the YouTube platform.

Assessing Contraceptive Switching and Discontinuation Over 3 Years in the HER Salt Lake Study.

To assess contraceptive switching and discontinuation among participants enrolled in a contraceptive access project over 3 years and to identify variables associated with contraceptive change. The HER Salt Lake study enrolled individuals between 2015 and 2017 from four clinics in Salt Lake County into a prospective, longitudinal cohort. All participants were able to switch or discontinue at no cost (between March 2016 and March 2020). We collected eight follow-up surveys over 3 years after enrollment. Each survey wave included questions about method use in the previous 4 weeks. We categorized participants in three ways, allowing for time-varying outcomes by wave: 1) those who reported using the same method as previous wave (continuers), 2) those who reported using a different method from previous wave (switchers), and 3) those who reported using no contraceptive method at that wave (discontinuers). We report the frequency of outcomes and conducted multinomial regression models assessing predictors of switching and discontinuation. Among 4,289 participants included in this analysis, 2,179 (50.8%) reported at least one instance of switching or discontinuation, and 2,110 (49.1%) reported continuing with their baseline method at the end of the study. Those reporting method change (switching or discontinuing) reported an average of 1.93 change events over the study follow-up period (range 1-8). Among those reporting any method change, 522 participants (23.9%) reporting at least one instance of both switching and discontinuation. Among those reporting any instance of discontinuation (n=966), 498 (51.6%) never reported uptake of a subsequent method. Among those who did report a subsequent method (n=468), 210 (44.8%) reported restarting a previously used method, and 258 (55.1%) reported starting a new method. Although we identified overlap among variables associated with switching and discontinuation, other predictors were discordant between switching and discontinuation. New contraceptive users commonly switch and discontinue methods. User behavior is associated with certain demographic characteristics and pregnancy planning. ClinicalTrials.gov , NCT02734199.

Double bad luck: pulmonary embolism and vaginal bleeding - a case report

BackgroundPulmonary embolism is a common and potentially fatal condition. Exogenous estrogens in contraceptives are associated with an increased risk of venous thrombo-embolism. However, discontinuation of a combined oral contraceptive can lead to severe withdrawal bleeding in an anticoagulated patient.Case presentationWe report a case of a 47-year-old female who presented to the emergency room with a two-day history of worsening shortness of breath and chest pain. Her chronic medication included a combined oral contraceptive pill. Transthoracic echocardiogram showed pulmonary hypertension and right ventricular dilatation. Computerized tomography scan revealed bilateral pulmonary embolism. She received thrombolysis with alteplase and was started on rivaroxaban. Five days after discharge, however, she was readmitted with severe vaginal bleeding.Discussion and conclusionWe describe a case of submassive pulmonary embolism, treated with thrombolysis and anticoagulation, who developed severe vaginal bleeding after stopping the contraceptive pill. This case highlights the importance of detailed menstrual history taking when initiating anticoagulation in women. Discontinuation of oral contraceptives, while important in reducing the risk of recurrent thrombosis, could be postponed until the end of the recommended course of anticoagulation and until a safe alternative form of contraception has been established, if required.

Predictors of contraceptive discontinuation in Rwanda: evidence from demographic and health survey 2019–2020

BackgroundDespite advancements, Rwanda continues to face challenges regarding contraceptive discontinuation. The 2019–2020 Rwanda Demographic and Health Survey (DHS) reported a 30% discontinuation rate among women within the first year of use. This study analyses predictors of discontinuation using this DHS data, with the goal of strengthening Rwanda’s family planning programs.MethodsData from the 2019-20 Rwanda DHS (14,634 women aged 15–49) was examined. A two-stage sampling design informed the survey. Life table methods and Cox proportional hazard models were used to analyze discontinuation rates, median usage duration across contraceptive methods, and the influence of demographic and other factors.ResultsResults indicated a progressive rise in contraceptive discontinuation over different period: 16.69% at 6 months, 29.29% at 12 months, and 47.21% at 24 months. Pills and male condoms showed higher discontinuation probabilities early on. While injectables and LAM initially showed lower discontinuation, rates rose significantly by the 24th month. Health concerns and side effects were the primary reasons cited for discontinuation. The Cox proportional hazards analysis revealed significant factors influencing discontinuation: contraceptive method, desire for pregnancy, husband’s disapproval, access/availability, and the desire for a more effective method.ConclusionThis study highlights substantial contraceptive discontinuation rates in Rwanda, particularly for pills and injectables. Method type, health concerns, side effects, and method failure were associated with discontinuation. Interventions should focus on improving contraceptive continuation and investigating alternative methods with lower discontinuation tendencies.

Contraceptive uptake among gender-expansive individuals in the HER Salt Lake Contraceptive Initiative

ObjectivesWe examined differences in contraceptive uptake and discontinuation between gender-expansive individuals and cis-women in the HER Salt Lake Contraceptive Initiative. Study designWe used self-reported survey data to assess associations between gender identity, contraceptive uptake, and discontinuation. ResultsOf participants (n = 4289), 178/4289 (4%) identified as gender-expansive with 157/178 (88%) reporting recent sexual activity with men. Selection of IUD or Implant was most common, with 109/178 (61%) of gender-expansive individuals choosing these options. We observed similar methods selected (p = 0.2) and discontinuation rates at three years between participants (OR: 0.93, p = 0.8). ConclusionGender-expansive individuals had similar method selection and discontinuation rates as cis-women. ImplicationsOur finding of no difference in the uptake of contraception between cis-women and gender-expansive individuals should empower providers to openly discuss contraception with patients regardless of gender identity.

Prevalence of modern contraceptive discontinuation and associated factors among married reproductive age group women in Debre Berhan town, Ethiopia: a community-based cross-sectional study

ObjectiveTo assess the prevalence of modern contraceptive discontinuation and associated factors among married reproductive age (15–49 years) group women.Study design, setting and participantsA community-based cross-sectional study was conducted in Debre...

The demand for male contraception: Estimating the potential market for users of novel male contraceptive methods using United States National Survey of Family Growth data

ObjectiveTo estimate the potential market for novel male contraceptives (NMCs) using United States National Survey of Family Growth (NSFG) data, 2015–2017. Study designWe described the market for NMCs via secondary analysis of the 2015–2017 NSFG’s weighted male respondent data, utilizing surrogate markers for contraceptive switching (NSFG) and contraceptive discontinuation data from the Contraceptive CHOICE project. Potential NMC users included men relying on: (1) no methods or less effective methods but who reported that they would be “very upset” if they got someone pregnant, (2) permanent methods but who reported that they might still want more children, (3) a female partner’s method that she might discontinue in the next year, (4) a male method even when his partner uses her own contraceptive. ResultsOf 3340 respondents—representing 55,890,830 sexually active, reproductive-age men—23.2% used no contraception at last intercourse, 15.8% condoms, 5.1% withdrawal, and 5.1% vasectomy. Among respondents relying solely on condoms, withdrawal, or no method, 19.7%, 3.8%, and 4.4% would be “very upset” if they got someone pregnant. For permanent contraceptive users, 17.3%−20.5% wanted another child. For men reliant on their partner’s long-acting reversible or combined hormonal contraceptive, 12–17% and 45–51% of partners might discontinue their method. These data conservatively suggest that 13% or more than 7 million men would potentially use NMCs, rising to 15.5 million with less restrictive contraceptive switching criteria. ConclusionAdjusting for pregnancy attitudes and likelihood of contraceptive switching, a substantial portion (between 7–15.5 million) of reproductive age men in the US are potential NMC users. ImplicationsThe population of potential novel male contraceptive users extends beyond just users of condoms, withdrawal and vasectomy and should include couples practicing dual-partner contraception and female partners using contraceptive methods that they may become dissatisfied with and discontinue.

Factors associated with the discontinuation of hormonal contraceptives in women of Lima, Peru.

Family planning is a right and a tool that offers the possibility of choosing how many children to have. Its importance lies in the possibility of avoiding an unwanted pregnancy and its consequences. Our objective was to determine the factors associated with discontinuing hormonal contraceptives in women of childbearing age who attended the La Libertad Health Center in January 2023. The study was observational, analytical, and cross-sectional. A total of 100 women of childbearing age who were users of hormonal contraceptives were included. Descriptive statistics were performed, frequency measurements and measures of central tendency were calculated, bivariate statistics were performed and the prevalence ratio (PR) was calculated, and a robust Poisson regression model was performed to assess the associated independent factors. All calculations were made with a confidence level of 95%. The educational level (PR=1.74; 95% CI: 1.22-2.48, p=0.006), the distance to the health center (PR=7.32; 95% CI: 1.1-48.5, p=0.001), having presented adverse events (PR=26.38; 95% CI: 3.8-183, p=0.001), and that the health staff had not identified the need for contraception (PR=3.12; 95% CI: 0.87-11.10, p=0.01) were associated with stopping a hormonal contraceptive. After introducing the variables to the regression model, the only independently associated factor was having presented an adverse event with the use of hormonal contraceptives (adjusted prevalence ratio, APR=3.33; 95% CI: 2.1-5.2, p<0.001). In this population, the factors associated with the discontinuation of hormonal contraceptives were education level, distance to the health center, having presented some adverse event with its use, and that health staff had not identified the need for contraception. The only independently associated factor was having presented an adverse event.

Hormonal Contraceptive Side Effects and Nonhormonal Alternatives on TikTok: A Content Analysis.

The use of hormonal contraceptives is decreasing in the United States alongside a growing interest in nonhormonal contraceptive options. Social media messaging may be contributing to this trend. TikTok thus offers a novel opportunity to understand how people share information about risks and alternatives for pregnancy prevention. To describe the availability and content of information about hormonal contraceptive side effects and nonhormonal contraceptive options on TikTok, we conducted a content analysis of 100 videos using the hashtags #birthcontrolsideeffects and #nonhormonalcontraception. We found that these videos were popular and often framed hormonal contraceptives and patient-provider interactions negatively, with users frequently discussing discontinuation of hormonal contraception and no plans for uptake of another contraceptive. When uptake of a new contraceptive method is mentioned, creators typically mention a fertility awareness-based method, which requires specialized knowledge to use safely and effectively. The risks and side effects of hormonal options were often overemphasized compared with the possible risks and side effects of nonhormonal options. This framing may suggest opportunities for providers and health educators to reassess how they counsel about contraceptive options. We conclude with recommendations for future research on TikTok and consider the policy implications of these findings.

Determinants of Contraceptive Discontinuation among Homeless Women in Kenya

This paper examines factors affecting contraceptive discontinuity among homeless women in Kenya, using data from a sample of 384 homeless women. The findings were estimated using logistic regression. The estimated results from regression analysis show that living with a partner, drug use, health facility delivery, and knowledge of female sterilization and previously emigrating from an urban area, strongly encourage contraceptive discontinuation. The estimated results further show that being assisted by a midwife during delivery, earning above a dollar a day, and going through neonatal or pregnancy loss reduces incidences of contraceptive discontinuation. The study concludes with implications for policies that will encourage consistent use of contraceptives. These policies include the establishment of family planning programs to curb drug abuse and setting up family planning programs to educate women on the importance of initiating a form of contraception after incidences of abortions, stillbirths, or miscarriages. Other policy recommendations include the establishment of drug rehabilitation centers for women struggling with drug abuse and the provision of alternative sources of income. The government is also advised to train more midwives who can offer home based care for homeless women who cannot visit health centers.

Contraceptive use and discontinuation among women aged 15-24 years in Kenya.

The 15-24-year-old age group of young women make up about 15% of the population of 47 million Kenyans which comes to 7 million. Addressing the reproductive health goals of this cohort is thus a policy priority because of the high potential they pose for unintended pregnancy through incorrect and intermittent use of contraception. The study sought to present evidence on contraceptive use among women aged 15-24 in Kenya between 2012 and 2014 using Kenya Demographic and Health Survey (KDHS) 2014 Contraceptive calendar data and make recommendations on enhancing the correct and consistent use of contraception. The data used was obtained from the Choices and Challenges tool developed by Population Reference Bureau (PRB) and visualized innovatively using Sankey Diagrams that show contraceptive use/non-use, continuation, switching/discontinuation, and pregnancy. The use of contraceptives went up by about 30% during the study period while the use of modern methods went up by 83%. The uptake of Long-Acting Reversible Contraception (LARC) went up by 87% while that of Short Acting Methods (SAM) went up by 70% but the progress was clouded by discontinuation rates of 35% with side effects being the leading reason for the abandonment of contraception. For Kenya to achieve transformative results in ending the unmet need for contraception and preventable maternal deaths, it is critical to sustaining the current gains in contraceptive prevalence rate (CPR) by promoting the retention of youth users and encouraging new users.