Contraceptive discontinuation is defined as starting contraceptive use and then stopping for any reason while still at risk of an unintended pregnancy (FP2020, 2015). It has been reported to be higher for short-acting methods such as condoms, injectables, pills and traditional methods as they can be discontinued by the user herself compared to long- acting reversible methods such as implants and the Intrauterine device (IUD) which require a visit to facility to discontinue. (FP2020, 2015; Kopp et al., 2017; Thobani et al., 2019). The method-related reasons and contraceptive failure have been reported as the predominant causes for contraceptive discontinuation (Ali et al., 2012).
Postpartum period in the first 12 months following childbirth has been associated with high unmet need for contraceptives coupled with unintended pregnancies (WHO, 2015). Breastfeeding practices and beliefs about return of menses as a marker of fertility resumption during the postpartum period, makes it difficult for women to determine their fertility risk. Thus, women are less motivated to start contraceptive use while breastfeeding (Borda and Winfrey, 2010; Singata-Madliki et al., 2018). Previous investigators have demonstrated that women who discontinue contraception use during the postpartum period may opt not to use any method (contraceptive discontinuation) or switch to different modern method (method switching) which is less effective than the previous method at preventing pregnancy, and thereby exposes women to risk of unintended pregnancy, abortions and mistimed pregnancies/births (Jain et al 2017; Singata-Madliki et al., 2018).
Sustaining postpartum contraception use is important for woman’s fertility because it ensures optimal birth spacing, prevents unintended pregnancies, abortion and has an impact on infant and child survival (WHO, 2013). Examining postpartum contraceptive discontinuation will shed a light on the knowledge gaps in contraceptive use such as trends and determinants for contraceptive discontinuation, and will help in reducing unmet need for family planning (Jackson & Glasier, 2011). It will also provide evidence for areas that require coordinated efforts between different stakeholders involved in family planning programs and the government. This will help to improvement quality of services for family planning and reduces the discontinuation postpartum contraception.
Previous studies from developing countries showed that, on average, 19–64% of women discontinued using reversible contraceptive methods by the 12th month of use (Ali et al., 2012; Mumah et al., 2015; TDHS 2015/16; Barden-O’Fallon et al., 2018; Safari et al, 2019; UN, 2019; Sato et al, 2020). The discontinuation rate for condoms within the first 12 months is higher than intrauterine devices (50% vs 13%, respectively), and up to 40% higher for other methods such as pill, injectable, periodic abstinence and withdrawal (Ali et al., 2012; Shiferaw Yideta et al., 2017; Thobani et al., 2019). Contraceptive discontinuation among women with no desire to get pregnant increases the risk for unwanted pregnancies (Jain et al 2017). This reflects a failure of family planning programs and services (Ali et al., 2012; Adal, 2017; Do Nascimento Chofakian et al., 2019; Samosir et al., 2019; Thobani et al., 2019).
According to Tanzania Demographic and Health Survey, only 15.5% and 22.4% of women reported using modern contraceptive methods at 3 months and 12 months post-delivery respectively, especially during postnatal visit probably due to contraceptive counselling (MoHCDGEC et al., 2016). A cohort study conducted in Northern Tanzania among 5,284 pregnant women who were followed from 6–15 months postpartum, reported that 34% of women initiated contraceptive use during the postpartum period and 25% of the participants started at 7 months postpartum (Keogh et al., 2011). Authors in this study noted that 18.8% of contraceptive users discontinued at 15 months postpartum. The reasons for contraceptive discontinuation include partner disapproval (32%), side-effects (6%), wanting a child (4%) and other reasons (37%) (Keogh et al., 2011). The most recent study in Tanzania reported that short contraceptive methods were associated with high rate of discontinuation compared to long term acting contraceptives (Safari et al. 2019).
There is scant information on contraceptive discontinuation rates, patterns and associated factors post-delivery. This study aimed to determine predictors of contraception discontinuation at 3, 6, 12 months postpartum among women of reproductive age in Arusha city and Meru district, Tanzania.