PRB

When women and couples have access to voluntary family planning and can choose whether, when, and how often to have children, multigenerational benefits accrue across the health, education, and economic sectors. Despite these benefits, 218 million women in low- and middle-income countries (LMICs) who want to delay or avoid pregnancy do not use modern contraceptive methods.

Contraceptive use dynamics, including how often women switch or stop using family planning methods, contribute to contraceptive prevalence rates, or the percentage of women currently using a particular method. Contraceptive use dynamics also play a role in determining reproductive outcomes like unintended pregnancy. However, data on contraceptive use dynamics can be difficult to analyze and interpret. Data are typically collected by asking women to recall their monthly contraceptive use over a period of several years, via retrospective calendars; the calendar data are then analyzed using advanced statistical methods. This complex process may help explain why data on contraceptive use dynamics are not used more often in policy and program decision-making. When decisionmakers better understand the data showing why women stop using contraception despite a preference to avoid pregnancy, they can promote policies and programs that enable continued use of and increased satisfaction with family planning services.

PACE’s Choices and Challenges tool provides an accessible, user-friendly resource on contraceptive use dynamics. Leveraging data on 13 LMICs from the Demographic and Health Survey Contraceptive Calendar, the tool features interactive visualizations that highlight key patterns of contraceptive discontinuation and method switching in these countries, as well as the reasons women stop using contraception.

Choices and Challenges now offers the latest data from Bangladesh, Mali, and Zambia. These countries represent diverse geographic, cultural, and programmatic contexts and demonstrate a wide range in the share of women using contraception: 17% in Mali, 50% in Zambia, and 62% in Bangladesh. Yet in each of these countries, at least one-third of surveyed women reported recently discontinuing contraceptive use while still intending to delay or avoid pregnancy, according to an analysis of the new data.

Here are some key takeaways from each country:

Bangladesh

• Concerns about side effects and other health issues lead women of all ages to stop using contraception, particularly injectables and implants, within two years of starting. This trend may suggest the need for improved contraceptive counseling to ensure women understand the potential side effects of their selected method and how to manage any health concerns. Concerns about side effects, which are often more common for hormonal methods of family planning, also suggest a need for continued contraceptive technology improvements and innovations.
• Among women ages 25 to 34, convenience, cost, and access are the most reported reasons for stopping the use of male condoms. Tools that make family planning more affordable (such as vouchers) and accessible (such as ensuring provision through pharmacies and drug shops) may increase continuation by reducing the financial or logistical burden on clients.
• The Ministry of Health and Family Welfare in Bangladesh has taken steps to address these takeaways by prioritizing improved provider services in its Costed Implementation Plan for the National Family Planning Programme, Bangladesh 2016-2020, to include establishing quality-assurance tools and more comprehensive training for contraceptive counseling.

Mali

• The most common reason women stop using contraception is the desire to become pregnant, particularly women younger than 25. Supporting women who wish to stop contraceptive use, including timely and affordable removal of long-acting reversible contraceptives such as intrauterine devices or implants, is an essential element of high-quality, women-centered care and upholds the core principles of voluntarism and informed choice.
• Women in Mali also cite side effects and other health issues as a reason for stopping contraceptive use, particularly related to the pill, injectables, and implants. As with Bangladesh, this may indicate the need for improved contraceptive counseling and greater method choice. In addition to comprehensive counseling on potential side effects, contraceptive counseling could include adaptations to better accommodate couples and/or target male partners, as some evidence suggests women with supportive partners are more likely to continue their method. Ultimately, decisionmakers should ensure women have knowledge of and access to the full range of contraceptive options, so that those who wish to avoid pregnancy but are unhappy with their current method can easily switch.

Zambia

• The desire for a more effective method was a common reason reported by women who stopped using male condoms, as well as women who discontinued traditional methods, emergency contraception, and female condoms. Addressing barriers that limit the supply of family planning methods, through efforts such as investing in the supply chain to reduce stockouts and providing high-quality training and mentorship for family planning providers, will increase access to a range of contraceptive options, including long-acting and permanent methods. The Zambia Integrated Family Planning Costed Implementation Plan and Business Case (2021-2026) acknowledges the challenges of matching supply to demand and has prioritized several approaches to better secure commodities in its results framework for the Zambia Family Planning Programme.

In each country, contraceptive continuation for those wanting to prevent unintended pregnancy could be increased through investments in better counseling strategies and expanded method options. Tailoring policy and program recommendations to the specific reasons women stop using contraceptive methods will help ensure family planning programs better meet women’s needs.

Interested in learning more how you and your team can use the Choices and Challenges tool? Email thepaceproject [at] prb.org.