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Reproductive outcomes following contraceptive discontinuation for method-related reasons: An analysis of 49 Demographic and Health Surveys

Contraceptive discontinuation for method-related reasons is a common experience in low- and middle-income countries (LMICs) and may heighten women’s risk of unintended pregnancy. Few studies have provided a comprehensive assessment of reproductive outcomes following contraceptive discontinuation in...

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Autores principales: Gemmill, Alison, Sarnak, Dana, Bradley, Sarah E. K., Brecker, Eve, Patierno, Kaitlyn
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631694/
https://www.ncbi.nlm.nih.gov/pubmed/37939155
http://dx.doi.org/10.1371/journal.pgph.0002143
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author Gemmill, Alison
Sarnak, Dana
Bradley, Sarah E. K.
Brecker, Eve
Patierno, Kaitlyn
author_facet Gemmill, Alison
Sarnak, Dana
Bradley, Sarah E. K.
Brecker, Eve
Patierno, Kaitlyn
author_sort Gemmill, Alison
collection PubMed
description Contraceptive discontinuation for method-related reasons is a common experience in low- and middle-income countries (LMICs) and may heighten women’s risk of unintended pregnancy. Few studies have provided a comprehensive assessment of reproductive outcomes following contraceptive discontinuation in LMICs over the last decade. Using cross-sectional data from 49 Demographic and Health Surveys, we applied competing risks estimation to calculate monthly probabilities of contraceptive resumption and pregnancy over a 12-month period among pooled, regional, and country-specific samples of women who discontinued contraception for method-related reasons (corresponding to 174,726 episodes of discontinuation). We also examined the pregnancy intention status of births/current pregnancies among those who became pregnant in the 12 months following contraceptive discontinuation for method-related reasons. In the pooled sample, the three-month probability of pregnancy and resumption of contraceptive use was 12% and 47%, respectively; by 12 months these probabilities increased to 22% and 55%, respectively. Country-specific analyses show that the probabilities of resuming contraception by three months ranged from 15% in Liberia, Mali, and Sierra Leone to 85% in Bangladesh. On average, the majority of pregnancies/births that occured following discontinuation for method-related reasons were subsequently reported as unintended. However, reports varied depending on when women became pregnant within the 12 months following discontinuation. Our findings suggest the need for more nuanced measures of contraceptive use dynamics—including measures that distinguish between women who resume use of contraception from women who remain at risk of pregnancy in the short period after discontinuation—to better inform specific policies and interventions, particularly aimed at those who remain at risk of pregnancy.
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spelling pubmed-106316942023-11-08 Reproductive outcomes following contraceptive discontinuation for method-related reasons: An analysis of 49 Demographic and Health Surveys Gemmill, Alison Sarnak, Dana Bradley, Sarah E. K. Brecker, Eve Patierno, Kaitlyn PLOS Glob Public Health Research Article Contraceptive discontinuation for method-related reasons is a common experience in low- and middle-income countries (LMICs) and may heighten women’s risk of unintended pregnancy. Few studies have provided a comprehensive assessment of reproductive outcomes following contraceptive discontinuation in LMICs over the last decade. Using cross-sectional data from 49 Demographic and Health Surveys, we applied competing risks estimation to calculate monthly probabilities of contraceptive resumption and pregnancy over a 12-month period among pooled, regional, and country-specific samples of women who discontinued contraception for method-related reasons (corresponding to 174,726 episodes of discontinuation). We also examined the pregnancy intention status of births/current pregnancies among those who became pregnant in the 12 months following contraceptive discontinuation for method-related reasons. In the pooled sample, the three-month probability of pregnancy and resumption of contraceptive use was 12% and 47%, respectively; by 12 months these probabilities increased to 22% and 55%, respectively. Country-specific analyses show that the probabilities of resuming contraception by three months ranged from 15% in Liberia, Mali, and Sierra Leone to 85% in Bangladesh. On average, the majority of pregnancies/births that occured following discontinuation for method-related reasons were subsequently reported as unintended. However, reports varied depending on when women became pregnant within the 12 months following discontinuation. Our findings suggest the need for more nuanced measures of contraceptive use dynamics—including measures that distinguish between women who resume use of contraception from women who remain at risk of pregnancy in the short period after discontinuation—to better inform specific policies and interventions, particularly aimed at those who remain at risk of pregnancy. Public Library of Science 2023-11-08 /pmc/articles/PMC10631694/ /pubmed/37939155 http://dx.doi.org/10.1371/journal.pgph.0002143 Text en © 2023 Gemmill et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Gemmill, Alison
Sarnak, Dana
Bradley, Sarah E. K.
Brecker, Eve
Patierno, Kaitlyn
Reproductive outcomes following contraceptive discontinuation for method-related reasons: An analysis of 49 Demographic and Health Surveys
title Reproductive outcomes following contraceptive discontinuation for method-related reasons: An analysis of 49 Demographic and Health Surveys
title_full Reproductive outcomes following contraceptive discontinuation for method-related reasons: An analysis of 49 Demographic and Health Surveys
title_fullStr Reproductive outcomes following contraceptive discontinuation for method-related reasons: An analysis of 49 Demographic and Health Surveys
title_full_unstemmed Reproductive outcomes following contraceptive discontinuation for method-related reasons: An analysis of 49 Demographic and Health Surveys
title_short Reproductive outcomes following contraceptive discontinuation for method-related reasons: An analysis of 49 Demographic and Health Surveys
title_sort reproductive outcomes following contraceptive discontinuation for method-related reasons: an analysis of 49 demographic and health surveys
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631694/
https://www.ncbi.nlm.nih.gov/pubmed/37939155
http://dx.doi.org/10.1371/journal.pgph.0002143
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