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

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.