Ali Mohamed M, Park Min Hae, Ngo Thoai D
Health Information and Statistics, Department of Information, Evidence and Research, Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt.
Research, Monitoring and Evaluation, Health System Department, Marie Stopes International, W1T 6LP London, United Kingdom.
Contraception. 2014 Jul;90(1):47-53. doi: 10.1016/j.contraception.2014.03.008. Epub 2014 Mar 17.
To examine the levels and determinants of switching to any reversible modern contraceptive method following intrauterine device (IUD) discontinuation due to method-related reasons among women in developing countries.
We analysed 5-year contraceptive calendar data from 14 Demographic and Health Surveys, conducted in 1993-2008 (n=218,092 women; 17,151 women contributed a total of 18,485 IUD episodes). Life-table methods were used to determine overall and cause-specific probabilities of IUD discontinuation at 12 months of use. For IUD episodes discontinued due to method-related reasons, the probability of switching to another reversible modern method within 3 months was estimated, overall and by place of residence, education level, motivation for use, age category and wealth tertiles. Country-specific rate ratios (RR) were estimated using generalized linear models, and pooled RRs using meta-analyses.
The median duration of uninterrupted IUD use was 37 months. At 12 months, median probability of discontinuation was 13.2% and median probability of discontinuation due to method-related reasons was 8.9%. Within 3 months of discontinuation due to method-related reasons, half of the women had switched to another reversible modern method, 12% switched to traditional methods, 12% became pregnant, and 25% remained at risk for pregnancy. More educated women were more likely to switch to another reversible modern method than women with primary education or less (pooled RR 1.47; 95% CI 1.10-1.96), as were women in the highest wealth tertile (pooled RR 1.38; 95% CI 1.04-1.83) and women who were limiting births (pooled RR 1.35; 95% CI 1.08-1.68).
Delays to switching and switching to less reliable methods following IUD discontinuation remain a problem, exposing women to the risk of unwanted pregnancy. Family planning programmes should aim to improve quality of services through strengthening of counselling and follow-up services to support women's continuation of effective methods.
The risk of unintended pregnancy following IUD discontinuation remains high in developing countries. The quality of family planning services may be an important factor in switching to alternative modern contraceptive methods. Service providers should focus on counselling services and follow-up of women to support the continued use of effective methods.
研究发展中国家女性因方法相关原因停用宫内节育器（IUD）后改用任何可逆现代避孕方法的水平及决定因素。
我们分析了1993 - 2008年期间14项人口与健康调查的5年避孕日历数据（n = 218,092名女性；17,151名女性共有18,485次IUD使用经历）。采用生命表法确定IUD使用12个月时的总体停用概率及特定原因停用概率。对于因方法相关原因停用IUD的情况，估计了在3个月内改用另一种可逆现代方法的概率，总体及按居住地、教育水平、使用动机、年龄类别和财富三分位数进行估计。使用广义线性模型估计国家特定率比（RR），并通过荟萃分析估计合并RR。
IUD连续使用的中位持续时间为37个月。在12个月时，停用的中位概率为13.2%，因方法相关原因停用的中位概率为8.9%。在因方法相关原因停用后的3个月内，一半的女性改用了另一种可逆现代方法，12%改用传统方法，12%怀孕，25%仍有怀孕风险。受教育程度较高的女性比小学及以下学历的女性更有可能改用另一种可逆现代方法（合并RR 1.47；95% CI 1.10 - 1.96），最高财富三分位数的女性（合并RR 1.38；95% CI 1.04 - 1.83）以及希望限制生育的女性（合并RR 1.35；95% CI 1.08 - 1.68）也是如此。
IUD停用后改用其他方法的延迟以及改用可靠性较低方法的情况仍然是个问题，使女性面临意外怀孕的风险。计划生育项目应旨在通过加强咨询和随访服务来提高服务质量，以支持女性继续使用有效方法。
在发展中国家，IUD停用后意外怀孕的风险仍然很高。计划生育服务的质量可能是改用替代现代避孕方法的一个重要因素。服务提供者应注重对女性的咨询服务和随访，以支持她们继续使用有效方法。
