Intrauterine contraceptive device discontinuation among Jordanian women: rate, causes and determinants.

OBJECTIVE To determine the intrauterine contraceptive device (IUD) discontinuation rate and its causes and related factors among women attending UNRWA health centres in Jordan. METHODS The study cohort comprised 371 women who had an IUD inserted during 1997 and who were interviewed during their visits to the health centres in the period January-March 2003. The main outcome measure was IUD discontinuation. RESULTS The incidence of IUD discontinuation in the first year following insertion was 17.5%. Approximately 32% of the study sample continued using their devices after 5 years. The average duration of IUD use was 36 months. Of the 371 women, 39.6% discontinued IUD use because of a desire to conceive, 18.6% because of side effects, 4.9% because they were sexually inactive and 1.6% because of opposition from the woman's family. The most common side effects reported as reasons for discontinuation were bleeding, infection and pain. Discontinuation was inversely related to current age, marital age and number of living children. Outside camp residents, previous contraceptive users and women with obstetric complications were significantly less likely to discontinue IUD use. CONCLUSIONS The crude cumulative rate of IUD discontinuation was 17.5% during the first year, suggesting a need to tackle the problem of discontinuation through effective educational strategies on the process of fertility and contraception. The most common reason for voluntary IUD removal was the women's desire to conceive. This suggests that improved counselling and good selection of candidates before IUD insertion is required.