1. Contraceptive discontinuation in urban Honduras Janine Barden-O’Fallon, PhD Ilene Speizer, PhD University of North Carolina at Chapel Hill, USA 29 September 2009

2. Overview Results from a one-year follow-up study with reversible method users conducted in Honduras, 2006-2007 The study was funded by USAID and implemented by MEASURE Evaluation in collaboration with Programas para el Desarollo de Infantes y Mujeres (PRODIM)

3. Contraceptive Discontinuation  Common, though varies by country  Most common during first 12 months of use  Contributes to unmet need  Can lead to unplanned pregnancy and unwanted births, resulting in negative public health outcomes

4. Objective  To determine how multiple factors affect contraceptive discontinuation among users of temporary methods over a one-year period  Demographic characteristics  Fertility motivations  Partner engagement  Quality of FP services  Experience of side effects  Method characteristics

5. Study Sites

6. Data: Panel study collected in 2 rounds  Baseline exit interviews with 800 women aged 15-44, attending a FP appointment in selected health facilities in which they received the injectable, IUD, or oral contraceptive pill  Women were both new and continuing users  There were no quotas by type of method  Follow-up interviews completed with 671 (84%) 1 year later

7. Study sample at baseline (n=671)  Young (94% under age 35)  Educated (30% reached secondary or higher)  Parity >/= 1  Married/in union (89%)  Urban residents (77%)  Desire to space a birth 2+ years (50%) or no more children (34%)

8. Method use by status of user at Baseline; N=671

9. Discontinuation Rate of Baseline Method, N= 324 Baseline Method @ 6 months @ 12 months Injectable0.250.50 IUD0.160.31 Pills0.220.44 TOTAL0.230.45 Results: Discontinuation was common…

10. Transition to First Episode of Non-Use, N= 324 Baseline Method @ 6 months @ 12 months Injectable0.140.30 IUD0.070.12 Pills0.060.28 TOTAL0.120.25 …But many switched to another method

11. Multivariate analysis: Cox proportional hazards models  Model 1: Time until discontinuation of baseline method  Model 2: Time until first episode of non-use of any method (Model 2)  Covariates: demographic characteristics, fertility motivations and family engagement, experience of side effects, baseline service quality, and user status at baseline  Stratified by baseline method

12. Demographic characteristics ** ***

13. Fertility motivations & family engagement * **

14. Experience with side effects

15. Service quality *

16. Discussion  More than 4 out of 10 women discontinued the baseline method  Living in rural areas may limit ability to successfully switch methods  Service quality had little effect on discontinuation  Family and friends may support continuation

17. MEASURE Evaluation is funded by the U.S. Agency for International Development and is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill in partnership with Futures Group International, ICF Macro, John Snow, Inc., Management Sciences for Health, and Tulane University. The views expressed in this presentation do not necessarily reflect the views of USAID or the United States Government. Thank you