CONTENTS
- Using Oral Contraceptives
- Continuation and Switching
- How Mass Media Can Help
- Pill Counseling
- Keeping Guidelines Up to Date
- Improving Access
HIGHLIGHTS
- Common problems using OCs
- When is missing pills riskiest?
- What to do about missed pills
- Quitting without switching
- Men can help
- Key messages for OC users
- Managing common side effects
- Removing unnecessary barriers
- When can a woman start the pill?
- Unresolved issues
Spring, 2000
Series A, Number 10
Oral Contraceptives
Women stop using the pill for various reasons. Some want to become pregnant. Others no longer need contraception. Still others may shift to another method that better meets their changing family planning needs. Many women, however, stop using the pill but do not switch to another method at once even though they remain sexually active and do not want to become pregnant. Some of these women remain unprotected for months, and a great many of them become pregnant (see side-bar, Most Pill Users' Pregnancies Occur When They Quit but Do Not Switch).
If the percentage of women who stopped pill use without switching to another method while still in need of contraception was reduced by one percentage point, 620,000 unintended pregnancies could be avoided each year.
 JHU/CCP |
Organon, a manufacturer of oral contraceptives, has produced a card that helps a woman remember to take a pill each day. The woman activates the card when she takes the first pill in a pack. Then the card beeps at the same time each day for three months. |
Continuation
Oral contraceptive continuation rates differ greatly among countries and programs. In 8 of 10 countries with available survey data, about two-thirds or fewer pill users continued OC use for 12 months or more, and half or fewer continued to use the pill for at least two years (see Figure 3). By comparison, in 7 of 9 countries with comparable data, two-thirds or more of IUD users continued using the IUD after two years (4, 58, 139, 153, 225).
Family planning programs often can help more women achieve their reproductive intentions if they focus on serving women already using a method rather than only on attracting new users (102). As contraceptive use becomes more widespread, continuing users increasingly outnumber potential new users. For example, in the US, only an estimated one-fifth of nearly 19 million pill users in one year had started the pill that year (181).
Short-term versus long-term use. Some women use OCs for only a short time—an average of four to six months (62, 177). Short-term users are most likely to discontinue because of side effects such as nausea, breakthrough bleeding, spotting, weight gain, and breast tenderness (124, 139, 180, 182, 192, 193, 227).
Although a substantial group of OC users quit within a few months, many other women are long-term OC users. Data that include short-term as well as long-term users demonstrate that many women rely on the pill for the long term. For example, in the mid-1990s median duration of pill use was 18 months in the Philippines (153) and 27 months in Indonesia (58). In Zimbabwe, where most family planning users rely on the pill, the median length of OC use was 28 months (186). A 1995 Canadian survey found that the average length of pill use was seven years, and that, among pill users over age 35, nearly 70% had used the pill for more than 10 years (17).
