1. 1. Socio-demographic factors
According to the study in Pakistan, majority of subjects (54%) were 25–35 years old, 37.8% of
them had less than five years of education (12). After adjusting for age, race, marital status, low
socioeconomic status, and history of sexually transmitted infection, Washington University
study revealed that single and divorced, /separated and widowed women were slightly more
likely to discontinue compared to married women (14).
2. Method related factors
Among 114 and 139 women who discontinued IUD and implant use before 30 months of use,
13.2% and 11.5% selected a new method in the most effective category, 40.4% and 48.9%
selected a moderately effective method, and 7.9% and 10.8% initiated a method in the least
effective category as well as, More than one third (38.6%) and nearly one third (28.8%) did not
initiate a new method, including five (4.4%) and eight women (5.8%) women who had at least a
2-week gap in contraceptive use, and 13 (11.4%) and 10 (7.2%) who discontinued use to attempt
conception respectively in Colorado (5).
Amongst the women who had their IUD removed, 56.5% did not switch to any other
contraceptive method, while 36.3% switched to either short-term or traditional methods, such as
withdrawal, rhythm, or folk methods. Degree of satisfaction with the device was also
significantly associated with discontinuation as study shown in Pakistan (11).
3. Obstetric related factors
Women who did not intend to have other children were less likely to have discontinued
contraceptive use. Previous use of the pill, intrauterine device (IUD), and injection were found
to be associated with approximately less than one time the discontinuation which was even
higher than that recorded by other acting methods (1).
Despite recommendations from the ACOG for use of LARC in most women, clinicians continue
to have misconceptions about the use of IUDs in younger, nulliparous women. For example, in
survey-based scenarios, only 27% of family physicians in South Carolina recommended an IUD
for a sexually active adolescent. Consistent with these misconceptions, this study found that
IUDs were more commonly used in older multiparous women. However, older multiparous
women were also more likely to have the IUD removed early(3).
According to the study in six countries (Bangladesh Dominican, Republic, Kazakhstan, Kenya,
Philippines, Zimbabwe)discontinuation to get pregnant was the second most common
contraceptive behavior prior to a live birth. Nearly 19% of live births in the Dominican Republic
occurred following discontinuation for reasons other than to get pregnant, while the
2. corresponding percentage was relatively low in Kazakhstan desire for (7.0%)(4).With the
exception of Zimbabwe, less than 4 percent of births classified as unintended occurred after
discontinuation due to desire for pregnancy. The majority of births reported as intended followed
either no use of contraception or discontinuation to get pregnant in all 6 countries (4).
As study conducted in low income African countries shows, across all modern method types,
there are two reasons given for the majority of discontinuations: interest in becoming pregnant,
and side effects/health concerns. The percentage of women who discontinued because they
wanted to become pregnant is highest for IUD discontinuations and lowest for implant
discontinuations(9).
Study in Pakistan shows fifteen percent had had their IUD removed because they wished to
become pregnant and 4.8% reported switching to a permanent method after expulsion of the
device(11).
4. Reasons for discontinuation
Nearly 19% of live births in the Dominican Republic occurred following discontinuation for
reasons other than to get pregnant, while the corresponding percentage was relatively low in
Kazakhstan desire for (7.0%) (4).
The most common primary reasons for IUD initiators’ discontinuation were pain (including
dyspareunia) (27.0%), bleeding (20.9%), “other”(17.4%), self-reported or documented
malposition or expulsion (15.7%), and desire for pregnancy (7.9%) and for that of implant
initiators were bleeding (49.3%), weight change (12.9%), “other” (10.7%), mood change
(10.0%), and desire for pregnancy (9.0%) study shows in Colorado (5).
According to the study in Dhaka, among the reasons for discontinuing implants (DWSIN),
menstrual abnormality in the form of menorrhagia or irregular per vaginal bleeding was most
common (within 1 year-21, after 1 year32). Other causes were Weight gain, discomfort without
any reason, local swelling, without any reason& pain at insertion site is 3,3,3,1 & 2 respectively
Causes of discontinuation due to no further need includes desire to become pregnant, marital
dissolution, husband abroad or death of husband, hysterectomy and menopause (6) and (DWSIN)
includes becoming pregnant while using the method (failure), method-related reasons,
cost/access, opposition, and other reasons unrelated to lack of need (9) as study shows in 69 low
income countries depending on DHS.
Despite their advantages, LARCs have key drawbacks. The use of synthetic progesterone,
progestin, in all LARCs is associated with breast pain, weight gain, bloating, and acne or greasy
skin. Changes in menstruation can also occur with LARCs. Some injectables such as Depo
Provera suspend menses (9). Present study which aimed at assessing the reasons of
3. discontinuation of LARC has revealed that the commonest reason among the three LARC
methods users was the change in their bleeding pattern (50%). 27.5% of females got their IUD
removed because of the change in bleeding pattern, almost same results (30%) have also been
depicted by Pakistan Demographic and health survey 2012-2013(12).
