Non-use and use of ineffective methods of contraception

This chapter estimates the burden of disease attributable to non-use of contraception and use of ineffective methods. The health outcomes include obstetric complications and abortion-related morbidity and mortality associated with unintended pregnancies (unwanted and mistimed). We have presented a model for linking data on contraceptive use and fertility preferences to unwanted births and unsafe abortions as intermediate outcomes, which were then related to the maternal disease burden. The health outcomes considered were the conditions associated with unsafe abortion and unwanted births. The abortion-related conditions are a separate subcategory and the risk of abortion-related consequences is directly proportional to the risk of an unsafe abortion. The obstetric conditions linked to unwanted births are maternal haemorrhage, maternal sepsis, hypertensive disorders of pregnancy, obstructed labour and other maternal conditions. The burden of these obstetric complications attributable to non-use of contraception was assumed to be proportional to the percentage of unwanted births among all births. Contraceptive use reduces the risk of unintended conception but does not altogether eliminate it, and failure rates are higher for traditional methods than for modern methods. The categorical variable “contraceptive use” has three levels of exposure: non-use, use of traditional methods and use of modern methods. Non-users experience the highest conception rates. The modern method category was used as the reference category for calculating the relative risk of having an abortion and an unwanted birth. Not all conceptions lead to an avoidable burden, since many pregnancies are desired. We calculated how many unintended pregnancies are expected in one year by first estimating the proportion of women who would become pregnant and combining this with the probability that the Chapter 15