Levels, trends, and reasons for switching contraceptive methods in 8 countries: a competing risks approach using Demographic and Health Survey calendar data

Sarah E.K. Bradley, Macro International Inc.
Hilary Schwandt, Johns Hopkins University
Shane Khan, Macro International Inc.

We estimate levels, trends, and reasons for contraceptive switching, disaggregated into switching from less-to-more and more-to-less effective methods. Data come from the two most recent DHS surveys in Armenia, Bangladesh, Colombia, the Dominican Republic, Egypt, Indonesia, Kenya, and Zimbabwe. We calculate the cumulative incidence of discontinuation due to switching using a competing risks approach. We then investigate methods switched from and to, and reasons for switching. Finally, we examine hazards of switching by method type controlling for user characteristics. Preliminary results show that switching contraceptive methods is more common from less to more effective methods in most countries, but is most common from more-to-less effective methods in Bangladesh and Indonesia. The most common reasons for switching are health concerns/side effects and wanting a more effective method. Results will help policymakers and program managers understand when and why women switch contraceptive methods, and highlight pathways to improve contraceptive adherence.