Contraceptive discontinuation and pregnancy rates among among oral contraceptive, vaginal ring and transdermal patch users at Philadelphia family planning clinics

Discontinuation of hormonal contraception is common and may raise the risk of unintended pregnancy. We sought to compare the frequency of contraceptive discontinuation and rates of reported pregnancy in a population of family planning patients receiving oral, vaginal, or transdermal contraceptives. Patient visit data was analyzed for family planning patients receiving services at 43 Philadelphia-area clinics during 2007-2008. Reported method was assessed at subsequent visits for 13,306 patients: 9971 reporting oral contraceptive use at initial visit, 1228 ring users, and 2107 patch users. For patients reporting no contraceptive method at subsequent visit, reasons for nonuse of a contraceptive method were analyzed.

Clients with documented ring or patch use at initial visit were significantly less likely than clients with documented oral contraceptive use at initial visit to report the same method at subsequent visit, and were significantly more likely to report no contraceptive method at subsequent visit; this difference was observed both in women aged 20 and younger, and in women aged 21 and over. Patch users were also significantly less likely than ring users to report the same method on subsequent visit. Among clients giving a reason for contraceptive nonuse, the percentage of initial patch users who reported a pregnancy was significantly higher than the percentage of initial oral contraceptive users. These results suggest that contraceptive discontinuation is common among family planning patients receiving vaginal and transdermal contraceptives; the observed discontinuation rates may have implications for pregnancy prevention among family planning patients.