Determinants of early implant discontinuation among low-income women

Abstract

The determinants of contraceptive implant discontinuation within six months of insertion were examined among 786 low-income women attending family planning clinics in three U.S. cities. The six-month cumulative life-table discontinuation rate was 7.6%. Menstrual side effects were the most common reasons given for early implant removal, although women who discontinued use were no more likely than those who continued with the method to report menstrual irregularities. Women who opted for early removal were more likely than those who continued with the method to experience headaches, hair loss, weight gain and arm infection. Logistic regression analysis indicates that dissatisfaction with prior contraceptive methods, a partner who wants a child within the next two years, perceived pressure from health care providers to choose the implant, exposure to negative media coverage and the number of implant side effects significantly predict early implant discontinuation. Women's social and demographic characteristics, Medicaid status and motivation to avoid an unplanned pregnancy were not significantly related to early removal.

PIP: This study examines early contraceptive implant discontinuation among low-income clinic patients in Dallas, New York, and Pittsburgh and the impact of negative media coverage of Norplant in the press. Interviews were conducted among 786 women during 1993-94 at baseline, prior to insertion, and 6 months later. The explanatory logistic model included sociodemographic characteristics of users, motivation to avoid unintended pregnancy, satisfaction with previous contraceptive methods, and negative media coverage of a method of birth control. The sample population included only 55% who had completed high school, 22% who were currently employed, and 94% with at least one prior pregnancy. 70% had had at least one unintended pregnancy. 29% had experienced two or more unintended pregnancies. 8% had had no live births. 60% of the women were adolescents at the time of their first birth. The cumulative life table 6-month discontinuation rate was 7.6% (58 women out of 786). The removal rate was 1.02 during month 2, 1.55 during month 3, and almost 1.50 during months 4-6. 28% had the implant removed due to menstrual side effects, 19% complained of headaches, and 10% had some arm discomfort. 9% experienced weight changes and early removal. 7% discontinued use due to mood changes, and 5% stated hair loss, chest pains, or negative media reports as the reasons. About 75% of discontinuers and continuers reported side effects due to less regular menstrual periods. Discontinuers were more likely than continuers to report headaches, hair loss, weight gain, and the perception of long-term health problems. Discontinuers were more likely to report arm infection. Among the 33% exposed to intense negative media coverage, only 15% discontinued use. Findings suggest that counselors should explore the fertility desires of a woman and her spouse and refrain from promoting a specific method.