Abstract:
This study aims to provide an in-depth
assessment of changes in contraceptive
dynamics among ever-married Egyptian women
based on calendar data from the 2008 and 2014
EDHS surveys. The sample from EDHS 2008
included 10,704 use segments and in EDHS 2014
it included 15,236. Single/multiple decrement
life tables were built to examine net rates
of discontinuation by reasons, and women’s
status after discontinuation (no longer in
need; method failure; switched to another
method; abandoned use while in need). The 12
months discontinuation rate in the 2014
survey is 30%. The magnitude of the current
increase is about 4.3 percentage points (2.3,
1.8, and 0.7 percentage points for the IUD,
pill, and injectable segments). The increase
occurred among all background groups, with
only two exceptions: it dropped in urban
Upper Egypt and among women in the highest
wealth index quintile. Five main reasons for
discontinuation are considered: contraceptive
failure, side effects/health concerns, other
method/service-related reasons, desire to get
pregnant, and not exposed to pregnancy. While
the highest reason-specific discontinuation
rate remains “side effects/health concerns,”
the second highest in EDHS 2008, “other
method/service-related reasons,” has dropped
significantly, and “desire to become
pregnant” has emerged in EDHS 2014 as the new
second highest reason-specific
discontinuation rate. Discontinuation-
specific rates due to method failure have
significantly increased. The reasons were
aggregated to reflect two main groups of
factors: “method/service-related” and
“reduced need.” The discontinuation rate for
the former has remained almost unchanged at
about 18%, while the latter has significantly
increased from 8% to 12% indicating a
meaningful shift in the reasons for
discontinuation away from method/service-
related reasons and toward need-based reasons
for all three methods. This trend is clear
and significant across all background
categories. The “method/service related”
reasons rate decreased in Upper Egypt and
especially in urban Upper Egypt. While
reducing fertility is an essential component
of Egypt’s development, the rise in the ideal
family size and the discontinuation driven by
the “desire to become pregnant” is a strong
indicator that the strategic target of
“avoiding unwanted births” may become a low
priority consideration on the agenda. The
main program related reasons for
discontinuation suggest that better
counseling might decrease failure rates and
improve switching behavior. The findings
suggest that there is a need to adopt
strategies aiming to ensure better use
compliance and longer duration of use
together with strategies to increase
contraceptive prevalence.