Adding a Question About Method Switching to the Method Information Index Is a Better Predictor of Contraceptive Continuation

INTRODUCTION: The Method Information Index (MII) is 1 of 18 core indicators used to monitor progress toward achieving Family Planning 2020's goal of 120 million more women using a modern method of family planning by 2020. The 3 questions of the MII are intended to measure informed choice at method initiation. Although routinely used in the Demographic and Health Surveys and the Performance Monitoring and Accountability 2020 project in cross-sectional household surveys, the MII may not adequately reflect all key aspects of quality of care or predict contraceptive continuation. In the current study, a question was added to the MII regarding the possibility of switching to a different contraceptive method if the current method is not suitable. The revised MII is referred to as MIIplus. METHODS: A total of 2,699 married women aged 15–49 who started a new episode of use of intrauterine device, injectable, or oral contraceptive pills between December 2016 and October 2017 were followed for 1 year in India and interviewed at method start and 3, 6, and 12 months later. Of these women, 2,267 were interviewed 3 months later and included in the analysis. Using 3 Cox proportional hazard models, we estimated hazard ratios for risk of discontinuation, based on the MII, MIIplus, and a recategorization of MIIplus into a 3-category variable. RESULTS: The modern method continuation rate 100 days (∼3 months) later was 91% overall. Women who received the information in MIIplus were more likely to continue using a method at 100 days (95%) compared to those who received information covered in the MII (82%) or less than 3 components of the MII (89%) (P<.001). Women who received all components in the MIIplus were 69% (adjusted hazard ratio, 0.31; 95% confidence interval: 0.17 to 0.61) less likely than those who received information in the MII to discontinue using a modern method 100 days later. Discontinuation was not significantly different between women who received information on less than the 3 components of the MII compared to the complete MII. CONCLUSION: We recommend including the question about the possibility of switching to another family planning method in routine measurement because it better predicts contraceptive continuation than the MII alone and ensures that another domain of quality of care is reflected in the measurement. When programs provide information on the possibility of switching, women are better informed about voluntary family planning choice and their options to continue family planning when a method is not suitable.