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Global Contraceptive Failure Rates: Who Is Most at Risk?

Sarah E K Bradley, Chelsea B Polis, Akinrinola Bankole

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    Summary

    Contraceptive failure contributes to unintended pregnancies globally. This study found failure rates are lower than previously thought, with youngest and poorest women facing the highest risks.

    Area of Science:

    • Reproductive Health
    • Global Health
    • Demography

    Background:

    • Contraceptive failure is a significant cause of unintended pregnancy worldwide.
    • Data quality from Demographic and Health Surveys (DHS) retrospective calendars varies, impacting reliability.
    • Estimating accurate contraceptive failure rates is crucial for public health interventions.

    Purpose of the Study:

    • To estimate method-specific 12-month contraceptive failure rates using high-quality DHS data.
    • To analyze variations in contraceptive failure rates based on demographic and socioeconomic factors.
    • To provide updated global estimates of contraceptive failure, particularly age-specific patterns.

    Main Methods:

    • Analysis of 105,322 contraceptive use episodes from 15 DHS surveys (1992-2014) with reliable calendar data.

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  • Utilized multilevel piecewise exponential hazard models to examine failure rate variations.
  • Focused on method-specific failure rates and their association with age, education, socioeconomic status, and other factors.

    • Main Results:

    • Estimated contraceptive failure rates are lower than US data and slightly higher than previous multi-survey studies including lower-quality data.
    • Strong age-related patterns observed: youngest users exhibit failure rates up to ten times higher than older women for some methods.
    • Poorest and youngest women face the highest risk of unintended pregnancy due to contraceptive failure.

    Conclusions:

    • Reliable DHS data yields lower contraceptive failure rate estimates than previously reported.
    • Age is a critical factor influencing contraceptive failure, with significant disparities.
    • Targeted interventions for young and socioeconomically disadvantaged women are essential to reduce unintended pregnancies.