CONTENTS

          Chapters
  1. Using Oral Contraceptives
  2. Continuation and Switching
  3. How Mass Media Can Help
  4. Pill Counseling
  5. Keeping Guidelines Up to Date
  6. Improving Access

HIGHLIGHTS

Population Reports is published by the Population Information Program, Center for Communication Programs, The Johns Hopkins School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202-4012, USA


Volume XXVIII, Number 2
Spring, 2000

Series A, Number 10
Oral Contraceptives

The Contraceptive Coverage Gap

Some women who want to avoid pregnancy face a gap in contraceptive coverage because they stop using the pill but do not adopt another family planning method (36, 168, 180). For example, in India during a year-long study, one-fourth of women who reported discontinuing OCs for reasons other than wanting a child did not adopt another method (65). In Bangladesh, among women who stopped using the pill within an 18-month period for any reason other than desiring pregnancy, half did not adopt another method (123). Among women in the Philippines who discontinued pill use and still needed contraception, 68% did not adopt a new method within one year (153). In Zimbabwe nearly three-fourths of such discontinuers were left without protection against pregnancy for over a year (186). In the US a 1995 survey found that 20% of pill discontinuers had not adopted another contraceptive method one year after they had stopped taking the pill (225).

This gap in contraceptive coverage leads to many pregnancies, since women quickly regain their fertility after discontinuing pill use. In Ghana, for example, 53% of women who stopped coming to a health facility for OCs became pregnant within four months. Of the women who waited more than four months to return, 75% became pregnant. Nearly 40% reported these pregnancies as unintended (227).

Switching Methods

While switching from one family planning method to another is every person's right, it should be exercised with full knowledge, because women who switch from the pill to another family planning method can increase their risk of unintended pregnancy (36, 168, 180). An analysis of use patterns among a group of US pill users over one year, extrapolated to all US pill users, attributed 194,000 unintended pregnancies to about 1.7 million women switching from OCs to a less effective method, including condoms, diaphragms, spermicide, other barrier methods, withdrawal, and periodic abstinence (181).

Among women in the Philippines who stopped using the pill, one-fourth switched to a traditional family planning method, yet none of these women wanted another pregnancy (153). Similarly, in Bangladesh 12% of pill users switching methods or discontinuing use changed to a traditional method (139).

Women who switch from OCs to long-term or permanent methods, of course, experience far fewer unintended pregnancies than women who switch to less effective methods. For example, of nearly 880,000 pill users in the US estimated to switch from the pill to an IUD or sterilization, about 11,000 would experience unintended pregnancy (181).

Pill users often switch to the IUD, implants, or sterilization once they have had all the children they want. In Finland, for example, the pill is the most common method used by women who have no children. The IUD is used almost exclusively by women who have had at least one child, while sterilization becomes more common among contraceptive users as they have more children (117). In Sri Lanka more than twice as many pill users over 30 years old switched from the pill to sterilization than did women under age 30 (109).

Many women who stop using the pill choose the pill again later. In Ghana, among women who had discontinued pill use and later returned to the same health facility to use family planning again, half chose the pill again (227). In Peru some 30% of women who stopped using the pill of their own accord started using it again within a year (119). A study in the US found that, one month after stopping pill use, 65% of women began using contraception again. Of these, over one-fifth were again using the pill. One year after discontinuing use, 80% had resumed contraception, and again one-fifth were taking the pill (225).


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