Bangladesh 1993-1994 Demographic and Health ... - Measure DHS

The month of interview and the two preceding months are ignored in order to avoid the bias that might beintroduced by an unrecognized pregnancy.The rates presented in Table 4.23 are cumulative one-year discontinuation rates and represent theproportion of users who discontinue use by 12 months after they start. The rates are calculated by dividingthe number ofdiscontinuations at each duration of use in single months by the number of months of exposureat that duration. The single-month rates are then cumulated to produce a one-year rate. In calculating rates,the reasons for discontinuation are treated as competing risks (net rates). For purposes of the table, thereasons are classified into four main categories: method failure (pregnancy), desire to become pregnant, sideeffects/health reasons, and all other reasons. Switching from one method to another is included in the lastcategory.The results indicate that half of users in Bangladesh stop using within 12 months of starting use; 4percent stop due to method failure, g percent because they want to become pregnant, 21 percent as a result0f side effects or health concerns, and 16 percent because of other reasons. Discontinuation rates vary bymethod. Not surprisingly, rates for the condom (72 percent) and withdrawal (55 percent) are considerablyhigher than for the IUD (37 percent) and the pill (45 percent). However, discontinuation rates for injectionare relatively high, considering that one dose is usually effective for three months. Fifty-eight percent ofinjection users discontinue within one year of starting, a rate that is higher than for the pill. Discontinuationrates for periodic abstinence are intermediate (45 percent).Side effects of the method or other health reasons are by far the most commonly reported reasons fordiscontinuing the pill, the IUD, and injection. Only a small proportion of users of these methods discontinuewithin one year because of method failure or to become pregnant. These two reasons account for a largerproportion of women who discontinue use of condoms, periodic abstinence and withdrawal; however, "otherreasons" account for the largest share of discontinuers of these methods.Further information on reasons for contraceptive discontinuation is presented in Table 4.24. This tableshows the percent distribution of all discontinuations occurring during the five years preceding the survey,regardless of whether they occurred during the first 12 months of use or not. Taking into account all methods.side effects (34 percent) is the reason given most frequently for discontinuation, followed by the desire to getpregnant (19 percent). Discontinuations of pill use and IUD use are most commonly due to side effects,followed by a desire to become pregnant and health concerns. Side effects is also a major cause ofdiscontinuation of injection. The fact that 1 in 10 segments of injection use is interrupted due to problemsin availability or accessibility is notable. The main reasons for discontinuing use of the condom andwithdrawal is disapproval of the husband and a desire to become pregnant. As for periodic abstinence, thedesire to become pregnant is the main cause of discontinuation. Method failure is an important reason fordiscontinuation of both periodic abstinence and withdrawal, accounting for 20 percent of discontinuationsfor both methods. Similarly, the desire to use more effective methods accounted for a not insignificantproportion of discontinuations of periodic abstinence and withdrawal.62