Discontinuation of Contraceptive Intrauterine Devices and Implants in Bangladesh

However, low rates of use and high rates of discontinuation of these methods have negative implications for programs seeking to achieve effective contraception in Bangladesh. The Bangladesh Family Planning program has long sought to increase the rates of acceptance and continuation of LARCs. The Directorate General of Family Planning (DGFP) is responsible for mobilizing the resources necessary to promote the use of IUDs and implants, including procurement and supply of devices, training of service providers, and provision of insertion fees and client compensation. These investments are most cost-effective when method acceptors continue to use LARCs throughout the effective life of the method. The contraceptive prevalence rate in Bangladesh was 62 percent in 2017-2018, and the modern-method use rate was 52 percent. IUDs and implants were the two least-used methods, with use rates of 1 percent and 2 percent, respectively. Longitudinal data on IUD and implant discontinuation conducted by Research for Decision Makers, an activity under the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), and MEASURE Evaluation, showed that 12-month IUD discontinuation was approximately 40 percent in the 2000s and increased to over 60 percent in the early 2010s. In contrast, implant discontinuation was lower, but it increased in recent years. Multivariate analysis confirmed the increasing trends of discontinuation of IUDs and implants. The rate of IUD discontinuation was lower among older women, and also lower among more-educated women. Implant discontinuation was higher among more-educated women. Method switching was common, with 42 percent of IUD users and 58 percent of implant users changing to "no use" or switching to another modern method. Contraceptive users mostly switched to pills and injectables. A few (about 3%) switched to other LARCs or permanent methods. The data indicate that increased discontinuation is partially associated with frequent method switching. This switching is often from LARCs to short-acting methods, and it leads to a less-effective contraceptive method mix. The Bangladesh Family Planning program should focus on increasing the use of IUDs and implants and decreasing the discontinuation rate of IUDs and implants, as well as short-acting methods such as pills and injectables. Enhancing counseling for IUD and implant clients, both before and after initiation of use, is an effective intervention to increase method continuation. Quality pre- and post-procedure counseling of clients is essential to reduce discontinuation of LARCs. Preventing and managing side effects of IUDs and implants, such as bleeding and lower back pain, is also crucial to reduce early discontinuation.