The Impact of Contraceptive Failure on Unintended Births and Induced Abortions

58 Pages·2011·0.69 MB·English

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sepTemBer 2011
This publication was produced for review by the United States Agency for International Development. It was prepared by
Sarah E.K. Bradley, Trevor N. Croft, and Shea O. Rutstein of ICF Macro.
MEASURE DHS assists countries worldwide in the collection and use of data to monitor and evaluate
population, health, and nutrition programs. Additional information about the MEASURE DHS project can
be obtained by contacting MEASURE DHS, ICF Macro, 11785 Beltsville Drive, Suite 300, Calverton,
MD 20705 (telephone: [phone]; fax: [phone]; e-mail: [email protected]; internet:
www.measuredhs.com).

The main objectives of the MEASURE DHS project are:
• to provide decisionmakers in survey countries with information useful for informed policy choices;
• to expand the international population and health database;
• to advance survey methodology; and
• to develop in participating countries the skills and resources necessary to conduct high-quality
demographic and health surveys.
DHS Analytical Studies No. 22
The Impact of Contraceptive Failure on Unintended Births and
Induced Abortions: Estimates and Strategies for Reduction
Sarah E.K. Bradley
Trevor N. Croft
Shea O. Rutstein
ICF Macro
Calverton, Maryland, USA
September 2011
Corresponding author: Sarah E.K. Bradley. Demographic and Health Research Division, ICF Macro, 11785
Beltsville Drive, Calverton, Maryland 20705, USA; Phone [phone]; Fax [phone]; Email:
[email protected]
Acknowledgements
Parts of an earlier version of this paper were presented at the Population Association of America
conference. We thank discussant Jane Menken and other conference participants for their feedback and
suggestions. Thanks to Tom Pullum for his review and useful comments, and to Bryant Robey for his
usual excellent edits. Special thanks to Kathryn Kost for a thoughtful, insightful review and helpful
suggestions.

Editor: Bryant Robey
Document Production: Yuan Gu

This study was carried out with support provided by the United States Agency for International
Development (USAID) through the MEASURE DHS project (#GPO-C-00-08-00008-00). The views
expressed are those of the authors and do not necessarily reflect the views of USAID or the United States
Government.

Recommended citation:

Bradley, Sarah E.K., Trevor N. Croft, and Shea O. Rutstein. 2011. The Impact of Contraceptive Failure
on Unintended Births and Induced Abortions: Estimates and Strategies for Reduction. DHS Analytical
Studies No. 22. Calverton, Maryland, USA: ICF Macro.
Contents
List of Tables ................................................................................................................................. iv
List of Figures ................................................................................................................................. v
Preface ........................................................................................................................................... vii
Executive Summary ....................................................................................................................... ix
1. Introduction ............................................................................................................................. 1
2. Data .......................................................................................................................................... 3
3. Methods ................................................................................................................................... 5
4. Results ..................................................................................................................................... 7
5. Limitations ............................................................................................................................. 28
6. Discussion and Conclusions .................................................................................................. 30
Methodological Appendix ............................................................................................................ 32
References ..................................................................................................................................... 39
iii
List of Tables
Table 1. Characteristics of sample and population, DHS surveys 2002-2010 ...........................5
Table 2. Percent distribution of all live births/pregnancies in the four-year period of
observation by wantedness status/birth outcome, DHS surveys 2002-2010 ................8
Table 3. Among live births and pregnancies in the four-year period of observation by
wantedness/termination status, percentage of each category that resulted from
contraceptive failure, DHS surveys 2002-2010 .........................................................11
Table 4. Contraceptive prevalence among all/ever married women age 15-49 by method
and country, DHS surveys 2002-2010 .......................................................................13
Table 5. First-year contraceptive failure rates by contraceptive methods, DHS surveys
2002-2010 ...................................................................................................................16
Table 6. First-year contraceptive failure rates by method type, DHS surveys 2002-2010 ......17
Table 7. Percentage of live births in the four-year period of observation by wantedness
status, total and as a result of contraceptive failure, DHS surveys 2002-2010 ..........20
Table 8. Percentage of pregnancies that ended in induced abortion in the four-year period
of observation, total and resulting from contraceptive failure, women age 15-49,
DHS surveys with abortion data 2002-2007 ..............................................................21
Table 9. Percentage of unintended births that could be avoided by using more effective
contraception, among women 15-49, DHS surveys 2002-2010 .................................24
Table 10. Number of unintended births that could be avoided per year by using more
effective contraception among women 15-49, Countries with DHS surveys,
2002-2010 ...................................................................................................................26
Table 11. Percentage of induced abortions that could be avoided by using more effective
contraception, among women 15-49, DHS surveys 2002-2007 .................................27
Table 12. Number of induced abortions that could be avoided per year by using more
effective contraception among women 15-49, Countries with abortion data from
DHS surveys, 2002-2007 ...........................................................................................28
Table A.1. Percent distribution of all live births/current pregnancies in the five years
preceding the survey by wantedness status/birth outcome, DHS surveys 2002-
2010 ............................................................................................................................35
Table A.2. Among current pregnancies and live births by wantedness status, percentage of
each category that resulted from contraceptive failure, DHS surveys 2002-2010 .....37

iv
List of Figures
Figure 1. Percentage of live births that were unintended, and percentage of all pregnancies
that were terminated among women age 15-49 ............................................................9
Figure 2. Contraceptive method mix among women age 15-49 using contraception ...............14
Figure 3. Failure rates by month by contraceptive method .......................................................18
Figure 4. Failure rates by month by contraceptive method type ...............................................19
Figure 5. Method used at time of conception of unintended births ...........................................22
Figure 6. Method used at time of conception of pregnancy leading to abortion .......................23

v

Preface
One of the most significant contributions of the MEASURE DHS program is the creation of an
internationally comparable body of data on the demographic and health characteristics of populations in
developing countries.
The DHS Comparative Reports series examines these data across countries in a comparative framework.
The DHS Analytical Studies series focuses on analysis of specific topics. The principal objectives of both
series are to provide information for policy formulation at the international level and to examine
individual country results in an international context.
While Comparative Reports are primarily descriptive, Analytical Studies comprise in-depth, focused
studies on a variety of substantive topics. The studies are based on a variable number of data sets,
depending on the topic being examined. A range of methodologies is used in these studies, including
multivariate statistical techniques.
The topics covered in Analytical Studies are selected by MEASURE DHS staff in conjunction with the
U.S. Agency for International Development.
It is anticipated that the DHS Analytical Studies will enhance the understanding of analysts and
policymakers regarding significant issues in the fields of international population and health.

Ann Way
Project Director
vii