Family planning service quality and contraceptive discontinuation among short-acting contraceptive users in Indonesia: a survival analysis of the 2017 Indonesia demographic health survey

Contraceptive discontinuation rates in Indonesia are higher among short-acting contraceptive users. The quality of family planning services was suspected to be the cause. The Indonesian Demographic Health Survey (IDHS) assesses family planning, discontinuation rates, and factors related to family planning. This study aimed to analyze short-acting contraceptive discontinuation and the quality of family planning services using The IDHS 2017 data.

This research analyzes data from the 2017 IDHS of women aged 15–49 years who had been using contraception in the last five years preceding the survey. Data on contraceptive discontinuation rates, reasons for discontinuation, contraceptive methods, sources of family planning services, caregivers, contraceptive decision makers, and contraceptive payment methods were extracted from the survey. Family planning service quality was assessed through the method information index (MII) from the 2017 IDHS. Survival analysis and the Cox proportional hazard model were used to analyze family planning service quality and contraceptive discontinuation.

The overall contraceptive discontinuation rate for short-acting contraceptive method (pills, injectable) in Indonesia was 43.6%. The complete MII or informed choice rate was 30%. Episodes with complete MII discontinue earlier than those incomplete. Approximately 60% of the discontinuations involved the use of injectables, but pill users discontinued earlier. The main reason for discontinuation is side effects. The Cox proportional hazard model revealed several variables that were significantly associated: complete MII (Hazard Ratio or HR 1.1), the use of a pill (HR 2.9) or an injectable contraceptive (HR 2.8), switching to other methods (HR 7.5), switching to long-acting reversible contraception (LARC) (HR 6,9), the use of other service sources (HR 2.0), age ≤ 29 years (HR 1.4), and age 30–34 years (HR 1.2).

The number of contraceptive discontinuation episodes in Indonesia was quite high, with few informed choices, although those with informed choices discontinued earlier. It is possible that those with informed choice acknowledge the contraceptive side effects and then choose to discontinue. Considering those who discontinue and switch to other methods, it is crucial to improve the quality of counseling with the aim of making optimal informed choices.