1. What characteristics differentiate method switchers from discontinuers? Janine Barden-O’Fallon, PhD Ilene Speizer, PhD University of North Carolina at Chapel Hill, USA 9 November 2010

2. Presenter Disclosure Janine Barden-O’Fallon (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose

3. Overview Findings 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)

4. Contraceptive Discontinuation  Common, though varies by country  Most common during first 12 months of use  7-20% due to “reduced need”  Contributes to unmet need  Can lead to unplanned pregnancy and unwanted births, resulting in negative public health outcomes

5. Objective  To examine differences between women who reinitiate contraceptive use immediately after a discontinuation (i.e. switch methods) and women who discontinue use and do not immediately begin another method (i.e. experience an episode of non-use).  Factors included in analysis: -Demographic characteristics -Communication -Fertility desires -Method characteristics -Service quality -Reason for discontinuation -Experience of side effects

6. Study Sites

7. 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 Data: Panel study collected in 2 rounds

8. Study sample (n=671) Compared to women who did not discontinue their baseline method (n=398), women who discontinued (n=273) were…  At a lower parity (47.6% vs. 41.7% with 0/1 child)  Not married at follow-up (15.7% vs. 7.3%)  Living in rural area (25.3% vs. 20.8%)  New to their method (53.1% vs. 45.0%)  Using the injectable (77.7% vs. 68.8%)

9. Significant factors related to women’s contraceptive status after discontinuation of baseline method (n=273) Characteristic Switchers (n=117) Discontinuers (n=156) Service at Baseline Had all questions answered by provider72.750.0 Side Effects Had side effects during the study89.769.9 Felt side effects interfered with daily activity54.735.3 Sought help from clinic/health worker55.628.2 Communication with others Discussed side effects with 2 or more people57.332.1 Discussed stopping BL method with partner before making decision to discontinue 86.360.3

10. Significant factors related to women’s contraceptive use after discontinuation among women experiencing the same side effect Side effect experiencedSwitchersDiscontinuers Amenorrhea (N=66)(n=22)(n=44) Self-medicated/took home remedies13.634.1 Sought help from a clinic/health worker63.636.4 Discussed SE with 2 or more people95.579.6 Heavy bleeding (N=64)(n=36)(n=28) Discussed SE with 2 or more people100.085.7 Discussed side effect with partner80.646.4 Discussed stopping with partner97.267.9 Headaches (N=82)(n=36)(n=46) Self-medicated/took home remedies36.156.5 Discussed stopping with partner88.969.6

11. Multivariate logistic regression  Dependent variable: switch vs. episode of non-use  Independent variables: from bivariate analysis  Women not experiencing side effects are included in null categories  Correlated variables not included in model: experience of side effects during study period; discussion of side effects with 2 or more people; discussion of side effects with partner; and discussion of side effects with a health worker.

12. Odds Ratios for demographic, side effects, and communication variables significantly related to the likelihood of switching methods; Honduras, 2006-7, N=270 **p<0.05 +new/recent method adopters**, +discontinuation due to method problems**

13. Limitations  Right and left censoring of the data; analytical censoring  Focus on switching behavior rather than duration of use

14. Conclusions  There are significant differences between women who switch methods and women who discontinue, beyond the main reason for discontinuation  Urban residence  Treatment seeking for side effects  Discussing discontinuation with partner

15. MEASURE Evaluation PRH is a MEASURE project funded by the United States Agency for International Development (USAID) through Cooperative Agreement GHA-A-00-08-00003- 00 and is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill in partnership with Futures Group International, Management Sciences for Health, and Tulane University. Views expressed in this presentation do not necessarily reflect the views of USAID or the U.S. Government. MEASURE Evaluation PRH supports improvements in monitoring and evaluation in population, health and nutrition worldwide.