IUD use, discontinuation and switching behavior in Bangladesh

Half of contracepting Bangladeshi couples discontinue use of their chosen method within one year of initiation. Over 30% of IUD users also discontinue within one year, with 63.7 percent stating that side effects and health concerns are the major reasons behind discontinuation. However, what do these reasons mean? Although some research around discontinuation has already been done in Bangladesh and elsewhere, studies have centered on identifying the socio-demographic characteristics of users associated with discontinuation. Little research has been done to understand the specifics of IUD use, counseling and management of side effects, discontinuation and switching, and the health system supports that are required to improve continuation rates.

The overall objective of this study is to quantify the outcome of IUD use and qualify the personal and service delivery factors contributing to IUD discontinuation, in six districts in Bangladesh. A retrospective cross-sectional design and multistage cluster sampling approach was employed. The respondents were IUD acceptors who had an IUD inserted one year before follow up, regardless of contraceptive outcome. A total of 375 IUD acceptors were selected randomly and interviewed from 120 facilities in 6 districts. In -depth interviews with a sample of discontinuers followed.

The data collection included: a) Acceptor survey, b) In-depth interviews with IUD discontinuers, and c) Interview with service providers. The primary use of the results will be to inform program managers about existing IUD use and to develop new program or approaches to improve IUD use in Bangladesh and elsewhere.