Abstract
This study aims to provide an in-depth assessment of changes in contraceptive dynamics among ever-married Egyptian women based on calendar data from the 2008 and 2014 EDHS surveys. The sample from EDHS 2008 included 10,704 use segments and in EDHS 2014 it included 15,236. Single/multiple decrement life tables were built to examine net rates of discontinuation by reasons, and women’s status after discontinuation (no longer in need; method failure; switched to another method; abandoned use while in need).
The 12 months discontinuation rate in the 2014 survey is 30%. The magnitude of the current increase is about 4.3 percentage points (2.3, 1.8, and 0.7 percentage points for the IUD, pill, and injectable segments). The increase occurred among all background groups, with only two exceptions: it dropped in urban Upper Egypt and among women in the highest wealth index quintile.
Five main reasons for discontinuation are considered: contraceptive failure, side effects/health concerns, other method/service-related reasons, desire to get pregnant, and not exposed to pregnancy. While the highest reason-specific discontinuation rate remains “side effects/health concerns,” the second highest in EDHS 2008, “other method/service-related reasons,” has dropped significantly, and “desire to become pregnant” has emerged in EDHS 2014 as the new second highest reason-specific discontinuation rate. Discontinuation-specific rates due to method failure have significantly increased.
The reasons were aggregated to reflect two main groups of factors: “method/service-related” and “reduced need.” The discontinuation rate for the former has remained almost unchanged at about 18%, while the latter has significantly increased from 8% to 12% indicating a meaningful shift in the reasons for discontinuation away from method/service-related reasons and toward need-based reasons for all three methods. This trend is clear and significant across all background categories. The “method/service related” reasons rate decreased in Upper Egypt and especially in urban Upper Egypt.
While reducing fertility is an essential component of Egypt’s development, the rise in the ideal family size and the discontinuation driven by the “desire to become pregnant” is a strong indicator that the strategic target of “avoiding unwanted births” may become a low priority consideration on the agenda. The main program related reasons for discontinuation suggest that better counseling might decrease failure rates and improve switching behavior. The findings suggest that there is a need to adopt strategies aiming to ensure better use compliance and longer duration of use together with strategies to increase contraceptive prevalence.
