Contraceptive discontinuation and unintended pregnancy: an imperfect relationship.

CONTEXT Contraceptive discontinuation is a common event that may be associated with low motivation to avoid pregnancy. If this is the case, a substantial proportion of pregnancies that follow discontinuation will be reported as intended. METHODS Demographic and Health Survey data from six countries (Bangladesh, the Dominican Republic, Kazakhstan, Kenya, the Philippines and Zimbabwe) over the period 1999-2003 were used to explore the proportions of pregnancies women reported as intended or unintended following various contraceptive behaviors. Multivariate logistic regression analysis was used to examine the characteristics of women who reported births as intended when they followed contraceptive failure or discontinuation for reasons other than a desire for pregnancy. RESULTS The proportion of births reported as intended following contraceptive failure ranged from 16% in Bangladesh to 54% in Kazakhstan, and the proportion reported as intended following discontinuation for reasons other than a desire for pregnancy ranged from 37% in Kenya to 51% in Kazakhstan. In at least half the countries, associations were found between selected women's characteristics and their reports that births following either contraceptive failure or discontinuation were intended: Factors that were positively associated were women's age and the time elapsed between contraceptive discontinuation and the index conception; factors that were negatively associated were increasing number of living children and reporting method failure as opposed to method discontinuation. CONCLUSION These findings suggest that underlying variation in the motivation to avoid pregnancy is an important factor in contraceptive discontinuation.