Discontinuation of modern contraception methods due to side effects and method failure in India: an analysis using reproductive calendar data


  • Mahesh R. Shete International Institute for Population Sciences, Mumbai, Maharashtra, India
  • Prakash Kumar International Institute for Population Sciences, Mumbai, Maharashtra, India
  • Enu Anand International Institute for Population Sciences, Mumbai, Maharashtra, India
  • Jayakant Singh School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
  • Manas Ranjan Pradhan Department of Fertility Studies, International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, India http://orcid.org/0000-0002-7011-894X




Modern methods, Contraceptive discontinuation, Side effect, Method failure, India


Background: Contraceptive discontinuation for reasons other than the desire to get pregnant is a significant public health concern. This study aimed to understand the elaborated role of side effects and method failure behind modern reversible contraception method discontinuation among married women aged 15-49 years in India.

Methods: The analysis was based on 142992 episodes of contraceptive use contributed by 90414 married women aged 15-49 years covered in the National family health survey-4 (2015-2016). Multivariate analyses, discontinuation rates using the multiple/single decrement life table and multi-level multinomial competing risk analyses were performed.

Results: Discontinuation rate due to side effects within 12 months of use was highest for injectables (14.7%) and lowest for male condoms (3%) and due to method failure, it was highest for male condoms (3%) and lowest among IUD users (1.2%). Compared to women using IUD, those using pills had 2.3 times and 1.6 times the higher hazard of discontinuation due to method failure and side effects, respectively.

Conclusions: The discontinuation rate of all selected methods was higher due to side effects than method failure. The high discontinuation rate of many contraceptive methods and the frequency of contraceptive failure suggest the need for strategies to promote improved contraceptive use following method selection. Improved quality of services through proper counselling of the potential contraceptive users would enhance informed choice, thus increasing modern contraception continuation among women in India.


Jain AK. Fertility reduction and the quality of family planning services. Stud Fam Plann. 1989;20(1):1-16.

Bruce J. Fundamental elements of the quality of care: a simple framework. Stud Fam Plann. 1990;21(2):61-91.

Jain AK, Hardee K. Revising the FP quality of care framework in the context of rights-based family planning. Stud Fam Plann. 2018;49(2):171-9.

United Nations. Levels and Trends of Contraceptive Use as Assessed in 2002. New York, 2006. Accessed on 23 June 2021. Available at: https://www.un.org/en/development/desa/population/publications/pdf/family/worldContraceptiveUseReport2002.pdf. Accessed on 10 June 2021.

United Nation Department of Economic and Social Affairs Population Divison. Trends in contraceptive use worldwide 2015. New York, 2015. Epub ahead of print 2015. Available at: https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/undesa_pd_report_2015_trends_contraceptive_use.pdf. Accessed on 20 June 2021.

RamaRao S, Lacuseta M, Costello M, Pangolibay B, Jones H. The link between quality of care and contraceptive use. Int Fam Plan Perspect. 2003;29(2):76-83.

Steele F, Curtis SL, Choe M. The impact of family planning service provision on contraceptive-use dynamics in Morocco. Stud Fam Plann. 1999;30(1):28-42.

Koenig MA, Foo GHC, Joshi K. Quality of care within the Indian family welfare programme: A review of recent evidence. Stud Fam Plann. 2000;31(1):1-18.

Bertrand J, Magnani RJ, Rutenberg N. Handbook of indicators for family planning program evaluation. North Carolina: US Aid; 1994.

Blanc AK, Curtis S, Croft T. Does contraceptive discontinuation matter? Quality of care and fertility consequences. North Carolina: US Aid; 1999.

Jain A, Bruce J, Mensch B. Setting standards of quality in family planning programs. Stud Fam Plann. 1992;23:392-5.

Vaughan B, Trussell J, Kost K, Singh S, Jones R. Discontinuation and resumption of contraceptive use: results from the 2002 National survey of family growth. Contraception. 2008;78(4):271-83.

Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397-404.

Curtis S, Evens E, Sambisa W. Contraceptive discontinuation and unintended pregnancy : an imperfect relationship. Int Perspect Sex Reprod Health. 2011;37(2):58-66.

Unintended Pregnancies in the Middle East and North Africa. Washington D.C., 2010. Epub ahead of print 2010. Available at: https://www.prb.org/resources/unintended-pregnancies-in-the-middle-east-and-north-africa/. Accessed on 20 June 2021.

Casterline JB, El-Zanaty F, El-Zeini LO. Unmet need and unintended fertility: longitudinal evidence from upper Egypt. Int Fam Plan Perspect. 2003;29(4):158-66.

Blanc AK, Curtis SL, Croft TN. Monitoring contraceptive continuation: links to fertility outcomes and quality of care. Stud Fam Plann. 2002;33(2):127-40.

Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006;38(2):90-6.

Jain AK, Winfrey W. Contribution of contraceptive discontinuation to unintended births in 36 developing countries. Stud Fam Plann. 2017;48(3):269-78.

Jain A. Should eliminating unment need for contraception continue to be a programme priority. Int Fam Plan Perspect. 1999;25:39-43.

Cleland J, Ali MM. Reproductive consequences of contraceptive failure in 19 developing countries. Obstet Gynecol. 2004;104(2):314-20.

Pariani S, Heer DM, Arsdol MD. Does choice make a difference to contraceptive use? Evidence from East Java. Stud Fam Plann. 1991;22(6):384-90.

Cotten N, Stanback J, Maidouka H. Early discontinuation of contraceptive use in Niger and The Gambia. Int Fam Plan Perspect. 1992;18:145-9.

Ali M, Cleland J. Contraceptive discontinuation in six developing countries: a cause-specific analysis. Int Fam Plan Perspect. 1995;21(3):92.

International Institite for Population Sciences (IIPS), ICF. National Family Health Survey (NFHS-4) 2015-16 India. 2017. Available at: http://rchiips.org/NFHS/NFHS-4Reports/India.pdf. Accessed on 10 June 2021.

DHS. DHS Contraceptive Calendar Tutorial. North Carolina: US Aid; 2018: 4-48.

Satagopan JM, Ben-Porat L, Berwick M, Robson M, Kutler D, Auerbach AD. A note on competing risks in survival data analysis. Br J Cancer. 2004;91(7):1229-35.

Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk a proportional hazards model for the sub distribution of a competing risk. J Am Stat Assoc. 1999;94(446):496-509.

Sharma M, Joshi S, Nagar O. Determinants of intrauterine contraceptive device discontinuation among Indian women. J Obstet Gynecol India. 2014;64:208-11.

Adal TG. Early discontinuation of long acting reversible contraceptives among married and in union women : a systematic review and meta-analysis. Ann Med Health Sci Res. 2017;7:113-8.

Vitzthum VJ, Ringheim K. Hormonal contraception and physiology: a research-based theory of discontinuation due to side effects. Stud Fam Plann. 2005;36(1):13-32.

Tolley E, Loza S, Kafafi L, Cummings S. The impact of menstrual side effects on contraceptive discontinuation: findings from a longitudinal study in Cairo, Egypt. Int Fam Plan Perspect. 2005;31(1):15-23.

Population Council. Fact sheet: Injectable Contraceptives: Perspectives and experiences of women and health care providers in India, 2012. Available at: https://knowledgecommons.popcouncil.org/. Accessed on 23 June 2021.

Westhoff CL, Heartwell S, Edwards S, Zieman M, Stuart G, Cwiak C, et al. Oral contraceptive discontinuation: do side effects matter? Am J Obstet Gynecol. 2007;196(4):412.

Dehlendorf C, Krajewski C, Borrero S. Contraceptive counseling: best practices to ensure quality communication and enable effective contraceptive use. Clin Obstet Gynecol. 2014;57(4):659-73.

Khan MA. Factors associated with oral contraceptive discontinuation in rural Bangladesh. Health Policy Plan. 2003;18(1):101-8.

Mensch B, Arends-Kuenning M, Jain A. The impact of the quality of family planning services on contraceptive use in Peru. Stud Fam Plann. 1996;27(2):59-75.

RamaRao S, Mohanam R. The quality of family planning programs: concepts, measurements, interventions, and effects. Stud Fam Plann. 2003;34(4):227-48.






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