Woman receiving contraceptive injection. Photo credit: David Rochkind, USAID
Around the world, a woman’s use of, and choice to use, contraception isn’t just a critical pillar of family planning, it’s a critical part of women’s empowerment and health. It’s key to achieving the Sustainable Development Goals, especially goal 3; which ensures healthy lives and promotes well-being for all ages. But in low and middle income countries, a significant percentage of women are discontinuing their use of contraceptives and very little attention in the global health community is being paid to the reasons behind the shift.
Why is this important?
At the most basic level, it’s a matter of health and safety. When women stop using their contraception it can lead to unwanted pregnancies that may need to be terminated through unsafe abortions. The phenomenon, coined ‘contraceptive discontinuation,’ in 2015 by FP2020 is when a woman begins using a method of contraception and then stops for any reason while still at risk of an unintended pregnancy.
According to Jay Gribble, Palladium Deputy Director of Family Planning and Reproductive Health, for development programs that provide family planning resources in low-and middle-income countries, having data to understand the reasons for stopping is critical. “To reduce discontinuation, we need to understand its underlying reasons and how policies, programs, and systems can be modified to make it a less frequent event,” he adds.
But in a larger sense, use of contraception is tremendously important for women in their decision to have or not have children. Access to and education on contraception is a matter of women’s health but for many women around the world, it’s not a given. “Too many women stop using family planning while not wanting to become pregnant,” explains Gribble, noting that some women discontinue contraceptive use because of side effects, health concerns, and—sadly—method failure.
The United States government through USAID is and has been the largest family planning donor globally. And while there’s a lot of upfront focus on the uptake of family planning, including the use of contraception, there’s a drop off in efforts to support its continued use. “Much attention is given to reducing unmet need by ensuring that women who do not want to become pregnant are using modern contraception,” explains Gribble.
“These efforts include innovative ways of providing services, ensuring availability of contraceptives and method choice to ensure that women and couples receive the needed support to continue using a method so that they can have the amount of children they want when they want them.”
A recent study examined data from Senegal and reported that, when considering the uptake of all family planning methods, 35% of women had ended use within 12 months of starting, increasing to 54% discontinuing by 24 months. It drives home an important point: many women who do not want to get pregnant stop using effective contraception for a variety of reasons, and not too long after they start.
“Given the investment made in helping women and couples to begin using contraception, these high levels of discontinuation warrant closer examination so that the global health community can better understand why it’s so high and identify solutions to reduce it,” adds Sara Stratton Palladium Director of Family Planning and Maternal and Child Health.
Both Gribble and Stratton co-edited a recent series of articles in conjunction with Health Policy Plus (HP+) called Rethinking Contraceptive Discontinuation: Are Solutions Being Overlooked? in which experts weighed in on how health systems and programs can address challenges. The series of articles culminated with a policy forum and discussion which highlighted three key approaches that could reduce discontinuation: empowering women, understanding context, and strengthening health systems.
“With greater empowerment, many women are more willing to use contraception in the first place,” explains Stratton. “Empowered women are better able to address some of the primary and secondary reasons for discontinuation.”
Empowered and supported women are likely more comfortable navigating the healthcare system or healthcare providers that may have paternalistic or ageist attitudes. Giving women a safe space to talk about personal issues or seek advice is a critical part of supporting women and creating groups via messaging apps or social media was one solution that came out of the policy forum and discussion.
But as Stratton adds, though empowering women is important, it requires also improving the system around them. “Women’s empowerment needs to be a broader cross-sectoral initiative that will advance not only health, but education, employment, and virtually every other aspect of the social fabric.”
While it’s not the only solution for contraception discontinuation, advancing women’s empowerment to have a more meaningful voice for themselves and their communities is and will continue to be a critical part of helping women find and use the contraceptive method that suits their life so that they and their partners can have the number of children they want when they want them.
Read the full series: Rethinking Contraception Discontinuation, or check out a related article: 'Black Women and Children are Dying in Birth in the U.S. – Can Employers Make a Difference?'. Contact firstname.lastname@example.org for more information.