Contraceptive Discontinuation Research Articles

Factors associated with the discontinuation of modern contraceptive methods among lactating women in nine West African high-fertility countries: findings of the most recent demographic and health surveys

IntroductionContraception discontinuation is a concern, especially if it occurs in breastfeeding women, thereby exposing them to a high risk of close and unwanted pregnancies. Our study aimed to measure the prevalence and identify the individual and community-level factors associated with the discontinuation of modern contraceptives among breastfeeding women.MethodsThis was a secondary analysis of retrospective data of the most recent Demographic and Health Surveys (DHS) data from nine high-fertility rate countries, conducted mostly between 2018–2021. We reported weighted frequencies of modern contraceptives discontinuation (binary variable, coded 1 and 0). The independent variables included individual-level variables, including sociodemographic characteristics, female reproduction and family planning history, the women and their households exposure to media, and community-level ones such as place of residence (urban and rural) and country. Multilevel-modified Poisson regression was used to identify associated factors at the 5% threshold.ResultsThe overall prevalence of modern contraceptives discontinuation was 13.1% among 5,599 lactating mothers, with wide variations between countries (prevalence ranging from 8.2% in Sierra Leone to 33.6% in Guinea). Women were more likely to discontinue contraception if they were the head of the household (adjusted prevalence ratio (aPR) = 1.71; 95% CI [1.17–2.50]; p = 0.006). In addition, compared to implant users, women using pills (aPR = 3.06; 95% CI [2.24–4.16]; p < 0.001), those using injectables (aPR = 2.80; 95% CI [2.16–3.62]; p < 0.001), and women whose partners used condoms (aPR = 2.30; 95% CI [1.47–3.59]; p < 0.001) were more likely to discontinue contraception. Moreover, women who were not sexually active (aPR = 2.11; 95% CI [1.75–2.54]; p < 0.001) and those who wanted children within two subsequent years (aPR = 1.84; 95% CI [1.36–2.48]; p < 0.001) were more likely to discontinue contraception. Finally, method discontinuation varied by country, with women in Gambia, Guinea, Mauritania, and Mali more likely to discontinue a modern contraceptive method than those living in Burkina Faso.ConclusionTo improve the retention of women using contraceptive, high-fertility rate countries need to focus on contraceptive education, communication about side effects, dissemination of family planning messages through the media, and regular monitoring of women taking contraceptives.

Mood lability and depression limit oral contraceptive therapy in endometriosis.

To determine the impact of oral contraceptive (OC) induced mood lability/depression on treatment maintenance in women with endometriosis. Women with endometriosis were retrospectively identified through International Classification of Diseases-10 codes and then a comprehensive electronic medical record review was conducted, identifying mood lability/depression as a reason for treatment discontinuation with the use of combined or progestin-only oral contraceptives. 2,682 women with endometriosis, between the ages of 18-45 treated in a university affiliated hospital between 2012-2024. Use of combined or progestin-only oral contraceptives in patients with endometriosis. The primary outcome was oral contraceptive discontinuation due to mood lability/depression in women with endometriosis. The secondary outcome assessed whether patients with a documented diagnosis of depression were more prone to discontinuing OC use due to mood lability. Mood lability/depression as a side effect of OC use was more common in women with endometriosis and increased the likelihood of discontinuing OCs. Overall, 44.2% of women with endometriosis and treated with OCs discontinued their use. The depression prevalence in our study cohort was 33.6%. Among those who discontinued, 33.9% attributed their discontinuation to mood lability/depression. Of those who discontinued OC use due to mood lability, 52.7% had a diagnosis of depression, a higher rate than those who discontinued OC use for other reasons or did not stop using OCs. There was no difference in OC discontinuation due to side effects comparing combination oral contraceptives to progestin-only oral contraceptives. Similarly, the type of progestin prescribed did not influence the OC discontinuation among those who experienced mood lability/depression. Women with endometriosis had an increased incidence of depression and a greater likelihood of discontinuing OCs when they experienced mood lability or depression. Mood lability played a significant role in OC discontinuation. The effect of oral contraceptive on mood lability/depression did not differ by the type of progestin. In patients with endometriosis at risk of depression, or who develop mood changes on oral contraceptives, other therapies that are typically considered second line should be considered early in the course of treatment.

Perinatal Management of Hepatic Adenomas.

With a strong association between hepatic adenomas and estrogen established, understanding the risks, evaluation, and perinatal management of hepatic adenomas is necessary for obstetric clinicians. The aim of this study is to review the preconception counseling, perinatal management, and postpartum care of hepatic adenomas. A literature review identified relevant research, review articles, textbook chapters, databases, and societal guidelines. Hepatic adenomas require individualized recommendations based on their prepregnancy size and evolution over pregnancy. Hepatic adenomas measuring greater than 5 cm are associated with a significantly increased risk during pregnancy including rupture. Ideally, optimal management of hepatic adenoma includes accurate diagnosis, discontinuation of estrogen-containing contraception, and surgical resection of large masses prior to conception. Patients should undergo serial surveillance of the adenoma during the antenatal and postpartum periods, with surgical intervention as indicated with multidisciplinary planning. An individualized approach is necessary when managing hepatic adenomas in the patient who is pregnant or intends pregnancy. More contemporary data are required to guide management and patient counseling.

Factors Influencing Discontinuation of Long-Acting Reversible Contraceptive Methods Among Women in Bahir Dar City, Northwest Ethiopia: A Cross-Sectional Study

IntroductionLong-acting reversible contraceptive discontinuation is the removal before completion of the intended lifespan of the method. Despite the improvement in utilization, discontinuation is becoming high. There is no study conducted on discontinuation and associated factors of long-acting reversible contraceptives in Bahir Dar City. The aim of this study was to assess the proportion and associated factors of discontinuation of Long-Acting Reversible Contraceptives among women in health facilities of Bahir Dar city, Northwest Ethiopia.MethodsA health facility-based cross-sectional design was conducted on 415 respondents from April 1 to May 30, 2021. A total of 11 health facilities were included and all reproductive age women who were using Long-acting reversible contraceptives came to the selected health facilities for any issue concerning the method before completion of life span of the method were included in this study. Data were collected through face-to-face interview questionnaires using a systematic random sampling method. Epi Data version 3.1 and Statistical Package for Social Sciences were used for data entry and analysis, respectively. Logistic regression analyses were used, and a P value less than 0.05 was considered a statistically significant factor for discontinuation.ResultsThe overall proportion of discontinuation of long-acting reversible contraceptives was 66.3% (95% CI: 61.42- 69.13). No formal education (AOR=0.49; 95% CI: 0.30-0.82,P: 0.021), primary education (AOR=0.39; 95% CI: 0.18-0.81, P:0.012), wish to pregnancy (AOR=2.57; 95% CI: 1.64 to 4.02,P: &lt;0.001), no history of contraceptive use (AOR=2.01; 95% CI: 1.19 to 3.38, P: 0.009), no counselling (AOR=1.68; 95% CI: 1.08-2.62,P: 0.021), and side effects (AOR=1.95; 95% CI: 1.21-3.16,P:0.006) were the factors associated with discontinuation.ConclusionsThe overall discontinuation of long-acting reversible contraceptives among women was low compared to Ethiopian Demographic Health Survey 2016. Practice pre-insertion counselling, early side effect management, create community awareness about the methods to decrease discontinuation, healthcare providers should perform their duties in line with the standards and quality of Long-acting reversible contraceptive service provision through qualitative research are recommended.

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 preexposure prophylaxis and depot medroxyprogesterone acetate contraception.

Injectable depot medroxyprogesterone acetate (DMPA) is the most common contraceptive choice among young women in Uganda, where HIV burden is high and HIV preexposure prophylaxis (PrEP) may be offered. For young women who choose to use both agents concurrently, it is unknown whether they will experience declines in bone mineral density (BMD) beyond those elicited by either product singly. From 2018 to 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 percent BMD change from baseline to month 12 for women using FTC/TDF and DMPA versus women using neither product. 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 to -1.56%, P = 0.001), total hip -2.24% (95% CI -3.87 to -0.60%, P = 0.009), and femoral neck -1.71% (95% CI -3.73 to 0.31%, P = 0.102). 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.