Frequency of discontinuation of contraceptive use: Results from a French population-based cohort

Background: Despite the widespread use of highly effective contraceptive methods in France, one in every three pregnancies is unintended. Among women experiencing an unintended pregnancy leading to an abortion, half had changed their contraceptive method in the 6 months preceding the abortion, in most cases switching to a less-effective method or to no method at all. This study provides estimates of method-specific contraceptive discontinuation rates for any reason and for method-related reasons among French women. Methods: The data were drawn from the COCON survey (2000-2004), a population-based French prospective cohort, comprising a representative sample of 2863 women aged 18-44. We estimated Kaplan-Meier life-table probabilities of contraceptive discontinuation during the 4 years of follow-up and tested for differences by intrauterine device (IUD) type and pill composition. Results: Probabilities of contraceptive discontinuation for method-related reasons varied widely by method: IUDs were associated with the lowest probabilities of discontinuation (11 within 12 months, 30 within 4 years), followed by the pill (22 and 48, respectively). Discontinuation rates were significantly higher for all other methods (condoms, withdrawal, fertility awareness methods and spermicides). We found no differences in discontinuation rates by the type of IUD (levonorgestrel-IUD versus copper-IUD) and increasing rates of pill discontinuation with decreasing dosage in estrogen. Conclusions: Contraceptive discontinuation rates among French women are substantially lower than those reported for US women. Comparing the determinants of contraceptive discontinuation and the role of healthcare providers in helping women make these changes would improve our understanding of the reasons for such variation.