The DHS Program

Uptake and Discontinuation of Long-Acting Reversible Contraceptives (LARCs) in Low-Income Countries (English) 

Document Type

Analytical Studies

Publication Topic(s)

Family Planning, Fertility and Fertility Preferences

Language

English

Recommended Citation

Staveteig, Sarah, Lindsay Mallick, and Rebecca Winter. 2015. Uptake and Discontinuation of Long-Acting Reversible Contraceptives (LARCs) in Low-Income Countries. DHS Analytical Studies No. 54. Rockville, Maryland, USA: ICF International.

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Publication Date

September 2015

Publication ID

AS54

Abstract:

Long-acting reversible contraceptive (LARC) methods—intrauterine devices (IUDs), implants, and injectables—together comprise a growing share of contraceptive use in low- income countries. Using DHS contraceptive calendar data this paper examines married women’s adoption and discontinuation of LARCs, other modern methods, and traditional/folkloric methods in 21 low- income countries. The two methods that require provider removal, IUDs and implants, have the lowest discontinuation rates. The discontinuation rate of injectables is on par with that of traditional methods and is lower than that of other non-LARC modern methods combined. Cost or access is rarely cited as an issue in discontinuation of any method. Failure rates of LARC methods are low, but four in ten episodes of LARC discontinuation are attributed to side effects or health concerns, more than double that of other modern methods combined. Three months after discontinuing while still in need (DWSIN), 15 to 20 percent of LARC users are at risk of an unwanted pregnancy. We model the hazard of DWSIN based on individual and country-level characteristics. Adjusted hazard models find that starting an IUD or injectable after birth, postpartum abstinence, or LAM significantly reduces the hazard of DWSIN. Additionally, living in a country with greater access to the method being used and higher-quality family planning programs reduces the hazard of DWSIN. These findings point to the benefits that postpartum family planning efforts and a supportive programmatic environment confer on sustained LARC use.