Indonesia is experiencing a great challenge in achieving replacement-level fertility, a total fertility rate of 2.1 children per woman. A persistent level of contraceptive discontinuation can contribute to this phenomenon. This study aims to examine the determinants of contraceptive discontinuation in Indonesia, using data from the 2017 Indonesia Demographic and Health Survey (DHS). We use the DHS monthly contraceptive calendar and the Gompertz proportional hazards model for analysis. The unit of analysis is the episode of contraceptive use during 3-62 months before the survey among women in union age 15-49. The outcome variable is the duration of the risk period up to the occurrence of the contraceptive discontinuation. The independent variables include a method-related factor (type of contraceptive method discontinued), demographic factors (age, parity, and contraceptive intent), and socioeconomic and cultural factors (internet use, mobile phone ownership, education, work status, place of residence, household wealth status, and women’s participation in decision-making).
The results of the study show that almost 3 of every 10 contraceptive use episodes in Indonesia were discontinued within 12 months of starting an interval of use. Discontinuations due to side effects and health concerns were by far the largest contributor to the overall discontinuation rate in Indonesia, with pill episodes showing the highest 12-month contraceptive discontinuation rates, followed by injectable episodes. The study also found that higher hazard of contraceptive discontinuation were associated with pill use compared with other methods, and for women who were older, had fewer children, spaced births, ever used the internet, had a mobile phone, had more education, were currently not employed, lived in a rural area, were in the lowest and second household wealth quintile, and did not participate in decision-making.
The findings from this study reveal important determinants of contraceptive discontinuation and present guidance crucial for improving family planning services in Indonesia in order to reduce unnecessary and unintentional contraceptive discontinuation. The higher contraceptive discontinuation due to side effects/health problems and for the two most favored methods, pills and injectables, may suggest a need for better provider-client communication and counseling, and improvements in contraceptive technology. Similarly, for women in the groups with higher risk of discontinuation, our findings suggest a need for more family planning counseling on contraceptive discontinuation management.