Oral

This session focuses on the determinants of effective, continuous contraceptive use by women in developing countries and the United States. Globally, unintended pregnancies are still a serious problem. According to the latest figures, nearly half of all pregnancies are unintended. It is estimated that about 1 in 5 pregnancies are aborted, often in unsafe conditions if performed in developing countries. Hence, it is important to gain a better understanding of why sexually-active women sometimes discontinue using contraceptive methods even though they do not want to get pregnant. In the first presentation, the researchers examined data on contraceptive discontinuation from eight developing countries. Continuation was found to be associated with method type: pill users were the most likely to continue. The main reasons given for discontinuing other methods were health concerns, side effects, method failure or inconvenience. Similar results were found from a study of young female contraceptive users from low-income clinics near San Francisco. Again, pill users were more likely to continue after one year. Discontinuation rates for other hormonal methods were as high as 75%. Long-acting reversible contraceptives, such as implants or intrauterine devices, might be more effective and appropriate. Where regular contraceptive use is low due to health concerns or access problems, emergency contraception (EC) and abortion may be higher. In urban Ghana, it was found that 28% of women had ever used EC, as compared with only 4% of American women in 2002. The last presentation sought to determine what would happen if low-income family planning clients in the US had to pay for services; results suggest that contraceptive effectiveness might decline by nearly 40%. Overall, these presentations suggest that improving contraceptive continuation and effectiveness requires more programmatic attention.

Session Objectives: 1) Explain why contraceptive methods in developing countries have differing discontinuation rates 2) Describe the contraceptive discontinuation rates of young women who start on an hormonal method 3) Identify correlates of emergency contraceptive use among urban women in Ghana 4) Describe how the efficacy of contraceptive methods used by low-income US women would decline if public family planning programs were eliminated

CE Credits: Medical (CME), Health Education (CHES), Nursing (CNE), Public Health (CPH)