Twelve-Month Discontinuation of Contraceptive Methods: A Global Systematic Review and Meta-Analysis

Monitoring contraceptive discontinuation is crucial to reduce unmet needs and unintended pregnancies while supporting person-centered counseling. The objective is to summarize discontinuation rates by method type (long-acting reversible contraceptive [LARC] or short-acting reversible contraceptive [SARC]), type (abandonment or switching), and to describe reasons for discontinuation. This systematic review and meta-analysis searched for studies published between 2010 and 2020, with data collected before the COVID-19 pandemic,among women of reproductive age. Random-effects models were used to pool 12-month discontinuation rates and estimate the likelihood of switching versus abandoning methods. Fifty-four studies were included. The 12-month discontinuation rate (unit of analysis: women) was 16.2 percent for LARC users (n = 867,658) and 57.9 percent for SARC users (n = 18,882). SARC users had lower odds of switching than abandoning their method (odds ratio: 0.17; 95 percent confidence interval: 0.06-0.54), whereas no significant difference was observed among LARC users. By episode use, 12-month discontinuation was 53.7 percent (n = 13,445) for SARC and 16.0 percent for LARC (n = 2,277), lower in postpartum women (8.5 percent) and higher among married women (22.5 percent). Pregnancy desire was the main reason for discontinuation among women not in need of contraception, whereas side effects predominated among those still in need. Monitoring contraceptive discontinuation is essential to guide public health policies and meet sexual and reproductive rights.