Estimating contraceptive continuation from aggregate clinical data

Abstract

The thesis attempts to examlne one very persistent problem with the use of contraceptives, namely, contraceptive continuation. Many developing countries have launched family planning programmes with the aim of recruiting contraceptive acceptors not only for the purpose of limiting fertility but also to improve the health of both the mother and the child. These family planning programmes have indeed had a substantial impact by way of promoting the use of modern contraceptive methods for purposes of curbing human fertility. Among the methods popularly used both in the developed and developing countries are oral contraceptives, also called pills, injectables, intrauterine devices (IUDs), foaming tablets and jellies, cervical caps and diaphragms. Many researches have been conducted on the continued use of these family planning methods using diverse approaches and the concept of continuation rate or conversely, discontinllation rate has become associated with many contraceptives. Contraceptive use-dynamics serve as a major measurement of a family planning programme quality Slnce client satisfaction with methods is reflected in continuation rates while client skill at using methods lS reflected in failure rates. In any family planning programme, it would be desirable to recruit a large v(llume of contraceptive acceptors and that these contraceptives provide protection against pregnancy for some considerable time of a woman's reproductive lifetime. This study presents a simple method of estimating contraceptive continuation rates which applies to aggragate programme acceptor data. The method uses counts of new and continuing contraceptive users from a number of clinics for every year since the clinic started operation. These data are then fitted 1n the discrete geometric continuation model. In order to estimate the continuation rates of pills, IUDs and injectables, Family Planning Association of Kenya (FPAK) data was used. To further supplement information on continuation rates, a sample of contraceptive users was analyzed to determine the demographic, social and economic factors associated with- contraceptive continuation rates and also to estimate the average duration a contraceptive method is used by acceptors. It 1S argued in this thesj~ that many factors interact to influence contraceptive continuation and using the continuation model developed by Hammerslough (1988), it is estimated that 50 per cent, 70 per cent and 60 per cent of pill, injectable and IUD users respectively will continue to use these methods after one year. The procedure presented in this study has very little data requirements and is designed in a way that family Planning Programme administrators will find it a tool easy to use for evaluation.