Determinants of Discontinuation and Switching of Oral Contraceptives in Brazil: Implications for Assessing Differentials in Quality of Family Planning Services

Iuri da Costa Leite, Escola Nacional de Saúde Pública
Neeru Gupta, IDEA International Institute

Contraceptive prevalence is relatively high in Brazil, with orals the most popular reversible method (27% in 1996). However, important differentials persist across sub-regions and social groups in family planning outcomes. This study examines the factors associated with discontinuation and switching of orals versus other reversible methods, with a focus on the mechanisms of contraceptive dynamics that might be linked with quality of care. Data are drawn from the Demographic and Health Survey calendar, and linked with municipal-level information on the health service environment. Multilevel discrete-time competing risks hazard models are used to estimate the fixed- and random-effects on the probability of a woman making a specific transition at a given duration of use. Preliminary findings reveal that orals accounted for over 50% of episodes of contraceptive use in 1991-96. Identifying the determinants of discontinuation and switching could assist program managers in improving service quality among all segments of the population.