# Discontinuation, switching and contraceptive failure patterns of long-acting reversible contraceptive users in Kenya: a quantitative study

## TL;DR

This study examines how users in Kenya discontinue, switch, or experience failure with long-acting contraceptives like IUDs and implants, finding higher failure rates and more pregnancy terminations after failure.

## Contribution

The study reveals underreported contraceptive failure rates and highlights unique patterns in LARC users' behaviors and outcomes.

## Key findings

- LARC users are less likely to discontinue or switch methods compared to other contraceptive users.
- Contraceptive failure may be underreported, with higher typical-use failure rates for LARC methods.
- LARC users are more likely to terminate pregnancies following contraceptive failure than users of other methods.

## Abstract

The number of IUD and implant (long-acting reversible contraceptive) users in sub-Saharan Africa is increasing. Yet, little is known about LARC users’ experiences and their discontinuation, switching, and failure rates. Contraceptive behaviours can support our understanding of users’ experiences and whether these methods meet their needs; this understanding can inform user-centred contraceptive programming and decision-making. This study applies event history analysis and life tables to the Kenyan Demographic and Health Survey contraceptive calendar data to examine LARC users’ behaviours and patterns compared to users of other methods. It also measures pregnancy outcomes following contraceptive failure by the method that failed. Results show that contraceptive failure may be under-estimated due to an underreporting or misreporting of failure. Alongside self-reported failure, this analysis uses a derived failure code, which finds that LARC typical-use failure rates may be higher than reported in other studies. LARC users are less likely to switch or discontinue methods compared to other contraceptive method users. However, early LARC discontinuation due to a desire to conceive increases with duration of use. Additionally, LARC users are more likely to experience pregnancy termination following method failure than users of other contraceptive methods. This study has implications for bodily and contraceptive autonomy, contraceptive user’s experiences, user-centred contraceptive counselling, and the provision of maternal health and abortion services.

Contraceptive users’ behaviour can highlight whether the methods they use meet their needs and allow them to achieve their reproductive goals. This study examines: (1) How often and how many users stop a method; (2) How long have they used it; (3) Whether they switch to another method and (4) If they experience contraceptive failure (becoming pregnant while using contraception). The study includes all contraceptive methods but has a specific focus on the IUD and implant. These are becoming increasingly popular in sub-Saharan Africa. Despite this increase, little is known about users’ experiences with these methods. Using quantitative methods, this research finds that contraceptive failure may be underreported, and the IUD and implant may fail more often than previously believed. IUD and implant users are also less likely to switch to another method or stop use compared to users of other methods. Following a contraceptive failure, IUD and implant users are more likely to experience a pregnancy termination compared to individuals whose method failed but were not using the IUD or implant. By analysing these patterns, this study aims to centre bodily and reproductive autonomy, improve contraceptive counselling, ensure methods better align with users’ preferences and support the healthcare system in anticipating demand for healthcare services.