Search results

In Egypt, the IUD is the most common contraceptive method since 1988 and has remained so despite a recent drop in its share from 59.9% in 2008 to 51.5% in 2014 in favour of hormonal methods, which increased from 19.7% for pills and 12.3% for injectables in 2008 to 27.4% and 14.5% in 2014 according to 2014 Egypt demographic and health survey (EDHS). The recent shift away from intrauterine contraceptive device (IUDs) to hormonal methods have contributed to increased discontinuation. This paper aims to answer three questions: To what extent does the method type influence the hazard of contraceptive discontinuation in Egypt? Is the interaction between method type and duration of use a predictor of the probability of discontinuation after controlling other variables? What are the other important background variables that affect the hazard of contraceptive discontinuation?

Using data from EDHS2014, separate multilevel discrete-time proportional hazard models for events of interest (abandoned use while in need, switched to another method in the month following discontinuation and method failure) were built.

Only IUD users are significantly less likely to abandon use while in need and to experience method failure and a reduced risk of switching. During the first 6–10 months of use, all types of discontinuation can be significantly reduced for all three methods. Demographic variables do not significantly affect abandonment but strongly affect switching and significantly affect failure. Socio-economic variables do not significantly affect abandonment and switching. Exposure to media has a significant effect on abandonment but not on switching. Community contraceptive prevalence rate strongly affects switching.

Results confirm that the counselling should be more intense during the first year of method use and should pay special attention to women who are 25 years old and above and those who have two or more children. Also, media campaigns are important and especially those addressing the issue of abandoning while in need.

The similarity of family planning (FP) indicators from EDHS2014 to that of EDHS2000 is alarming for policymakers and researchers who consider it as an echo of the past and a threat, which the FP programme has to face to prevent its progression. In 2000, the total fertility rate (TFR) was 3.5, the contraceptive prevalence rate was 56.1% and the discontinuation rate was 29.5%. In 2014, these indicators were 3.5, 58.5 and 30.1%, respectively. Although the change in the all method discontinuation rate is not large, it is a result of great changes in the method specific discontinuation rates, which was masked by changes in the contraceptive method mix. This study aims to present a comparison between contraceptive discontinuation rates in 2000, 2008 and 2014, discuss the reasons for discontinuation by methods and background characteristics of women and calculate the impact of eliminating discontinuation for reasons related to method and service provision on fertility.

Single/multiple decrement life tables were applied to the calendar data of the EDHS2008 and EDHS2014, to examine various net rates of contraceptive discontinuation by reasons and the status after discontinuation. The TFR estimated in the absence of method failure and abandonment while in need of births occurred within 24 months after discontinuation using installed Stata command tfr2.

The study estimates the impact of discontinuation on the TFR in 2014 to be an increase of about 20%. The TFR of 3.5 would have been only 2.8 if discontinuation due to method failure and method/service-related reasons were eliminated. Improvement regarding discontinuation behaviour is evident by increased switching, from 43.6 to 54.3% and the drop in the proportion of abandoning use while in need from 56.4 to 45.7%. Differentials suggest that discontinuation is expected to increase among vulnerable groups as desired fertility continues to rise. The increase in the share of “desire to become pregnant” – as a reason for discontinuation is a recent trend observed during the period between EDHS2008 and EDHS2014 and is recognised as a challenge by the national population strategy.

This study confirms that contraceptive discontinuation is an important part of the overall fertility increase observed by EDHS2014. The rising trend of increased desired family size and the shift away from using the intra uterine device may be considered as major challenges facing the FP programme in Egypt.