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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

What characteristics differentiate method switchers from discontinuers?

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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. Presenter Disclosure. Janine Barden-O’Fallon - PowerPoint PPT Presentation

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Page 1: What characteristics differentiate method switchers from discontinuers?

What characteristics differentiate method switchers

from discontinuers?

Janine Barden-O’Fallon, PhDIlene Speizer, PhD

University of North Carolina at Chapel Hill, USA9 November 2010

Page 2: What characteristics differentiate method switchers from discontinuers?

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

Page 3: What characteristics differentiate method switchers from discontinuers?

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)

Page 4: What characteristics differentiate method switchers from discontinuers?

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

Page 5: What characteristics differentiate method switchers from discontinuers?

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

Page 6: What characteristics differentiate method switchers from discontinuers?

Study Sites

Page 7: What characteristics differentiate method switchers from discontinuers?

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

Page 8: What characteristics differentiate method switchers from discontinuers?

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%)

Page 9: What characteristics differentiate method switchers from discontinuers?

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 provider 72.7 50.0

Side Effects Had side effects during the study 89.7 69.9

Felt side effects interfered with daily activity 54.7 35.3

Sought help from clinic/health worker 55.6 28.2

Communication with others Discussed side effects with 2 or more people 57.3 32.1

Discussed stopping BL method with partner before making decision to discontinue

86.3 60.3

Page 10: What characteristics differentiate method switchers from discontinuers?

Significant factors related to women’s contraceptive use after discontinuation among women experiencing the same side effectSide effect experienced Switchers DiscontinuersAmenorrhea (N=66) (n=22) (n=44) Self-medicated/took home remedies 13.6 34.1 Sought help from a clinic/health worker 63.6 36.4 Discussed SE with 2 or more people 95.5 79.6Heavy bleeding (N=64) (n=36) (n=28) Discussed SE with 2 or more people 100.0 85.7 Discussed side effect with partner 80.6 46.4 Discussed stopping with partner 97.2 67.9Headaches (N=82) (n=36) (n=46) Self-medicated/took home remedies 36.1 56.5 Discussed stopping with partner 88.9 69.6

Page 11: What characteristics differentiate method switchers from discontinuers?

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.

Page 12: What characteristics differentiate method switchers from discontinuers?

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**

Page 13: What characteristics differentiate method switchers from discontinuers?

Limitations

Right and left censoring of the data; analytical censoring

Focus on switching behavior rather than duration of use

Page 14: What characteristics differentiate method switchers from discontinuers?

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

Page 15: What characteristics differentiate method switchers from discontinuers?

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.