Typical-use contraceptive failure rates in 43 countries with Demographic and Health Survey data: summary of a detailed report

Abstract

Background: While most unintended pregnancies occur because couples do not use contraception, contraceptive failure is also an important underlying cause. However, few recent studies outside of the United States have estimated contraceptive failure rates, and most such studies have been restricted to married women, to a limited number of countries and to 12-month failure rate estimates.

Methods: Using self-reported data from 43 countries with Demographic and Health Survey data, we estimated typical-use contraceptive failure rates for seven contraceptive methods at 12, 24 and 36months of use. We provide a median estimate for each method across 43 countries overall, in seven subregions and in individual countries. We assess differences by various demographic and socioeconomic characteristics. Estimates are not corrected for potential errors in retrospective reporting contraceptive use or potential underreporting of abortion, which may vary by country and subgroups within countries.

Results: Across all included countries, reported 12-month typical-use failure rates were lowest for users of longer-acting methods such as implants (0.6 failures per 100 episodes of use), intrauterine devices (1.4) and injectables (1.7); intermediate for users of short-term resupply methods such as oral contraceptive pills (5.5) and male condoms (5.4); and highest for users of traditional methods such as withdrawal (13.4) or periodic abstinence (13.9), a group largely using calendar rhythm.

Conclusions: Our findings help us to highlight those methods, subregions and population groups that may be in need of particular attention for improvements in policies and programs to address higher contraceptive failure rates.

Keywords: Contraception; Failure rates; International; Life tables; Unintended pregnancy.

Fig. 1

Current use of modern or traditional contraception among women 15–49, by subregion. Note: E Africa=Eastern Africa. W Africa=Western Africa. N Afr/W Asia=Northern Africa and Western Asia. E Eur/C Asia=Eastern Europe and Central Asia. S Asia=Southern Asia. SE Asia=Southeastern Asia. We defined the following to be modern methods: male and female sterilization; implants; IUDs; injectables; oral contraceptive pills; male and female condoms; diaphragms; foam, jelly and spermicides; Standard Days Method; emergency contraception; fertility wheel calculator; and the Mucus/Billings/Basal body/Symptothermal method. Not all of these methods were asked about in all surveys. We defined the following to be traditional methods: periodic abstinence; withdrawal; Lactational Amenorrhea Method (LAM); and other traditional, local or folk methods.

Fig. 2

Method mix among current contraceptive users 15–49 by subregion. Note: Subregional estimates are not weighted by country population sizes; rather, each country within a subregion contributes equally to the subregional estimate. E Africa=Eastern Africa. W Africa=Western Africa. N Afr/W Asia=Northern Africa and Western Asia. E Eur/C Asia=Eastern Europe and Central Asia. S Asia=Southern Asia. SE Asia=Southeastern Asia. For countries that are included in the distribution for each subregion, see Fig. 1.

Fig. 3

Twelve-month typical-use contraceptive failure rate (median) by method. Notes: Median failure rates across all countries contributing data for a given method were calculated by including estimates from countries with 125 or more unweighted episodes of contraceptive use at life table month 1. Width of box is the interquartile range (IQR); whiskers are drawn to the lowest and highest values inside the area defined by Q1–1.5(IQR) and Q3+1.5(IQR); outliers beyond these ranges are depicted as individual dots.

Fig. 4

Twelve-month typical-use contraceptive failure rates and overall median (pooled estimates) by method and subregion. Notes: The implant estimate for Northern Africa and Western Asia is based on fewer than 250 unweighted episodes of implant use at month 1 (all occurring in Egypt or Jordan), so it should be interpreted with caution. The implant estimate in Eastern Europe and Central Asia is not reported because of insufficient episodes of implant use (n=6 at month 1) for estimation. Vertical red line indicates 12-month median estimates displayed in Fig. 3. E Africa=Eastern Africa. W Africa=Western Africa. N Afr/W Asia=Northern Africa and Western Asia. E Eur/C Asia=Eastern Europe and Central Asia. S Asia=Southern Asia. SE Asia=Southeastern Asia.

Fig. 5

Twelve-month typical-use contraceptive failure rates by age and method (pooled estimates). Note: Age was measured at the end of the episode of use.

Fig. 6

Twelve-month typical-use contraceptive failure rates by marital status and method (pooled estimates). Note: Marital status was measured at the end of the episode of use.