Even though almost 80% of sexually active Thai women use modern contraceptives, yet unintended pregnancy remains a significant reproductive health issue. One possible explanation is that the women do not use contraceptives or stopped using contraceptives at some point in their lifetime. At present, there is scant information available about contraceptive discontinuation among Thai women. We assessed the discontinuation rate and the reason for discontinuation of the four most common contraceptives used by reproductive aged Thai women: combined oral contraceptive pills (COCs), depot medroxyprogesterone acetate (DMPA), copper IUD, and contraceptive implant(s).
There were 1,880 women aged 18-45 years recruited from the Family Planning Clinic of the Chulalongkorn Hospital in Bangkok. The participants were followed at months 3, 6 and 12 either by attending the clinic or being interviewed via a phone call. Incidence density and cumulative incidence based on the Kaplan-Meier approach were used to assess contraceptive discontinuation. Cox proportional hazards model was used to determine significant personal risks of discontinuing contraceptive.
Among all, 839 (44.6%) women initiated COCs; 494 (26.3%) initiated DMPA; 280 (14.9%) initiated copper IUD and 267 (14.2%) initiated contraceptive implant(s). The incidence density for discontinuation of COCs, DMPA, copper IUD, and contraceptive implant(s) were 21.33, 9.21, 4.36, and 2.26 / 100 person-year, respectively. Most of the women (185/222) discontinued their contraceptives because of the side effects. Compared to the contraceptive implant(s) users, adjusted HR (95% CI) of discontinuing COCs, DMPA, and copper IUD were 9.92 (4.38-22.46), 4.25 (1.81-9.98), 2.16 (0.81-5.76), respectively. Lower-income, higher parity numbers, history of miscarriage, and history of abortion were independent predictors of contraceptive discontinuation in a multivariable model.
The discontinuation rate of COCs, the most popular contraceptive method for Thai women, was the highest during the one-year period of the study. The primary reason for discontinuing the use of the various contraceptive methods was the side effects.