Contraceptive failure: Levels, trends and determinants in Matlab, Bangladesh

This study investigated the levels, trends and determinants of contraceptiv e use-failure in Matlab, Bangladesh, using a set of prospective data on 25, 960 women of reproductive age. The data were extracted from the Record Keep ing System (RKS) of Matlab for the period 1978-94. If there was any live bi rth during the use or within 7 months after the discontinuation of use, it was considered as a failure. The life table technique and hazard model were used as analytical tools. The results suggest that use-failure for pills, IUDs (TCu 200) and injectables and other temporary methods increased from 1 978 to 1988, but began to decline after 1988. The cumulative probability of first-method failure within 1 year of method acceptance of the cohort of 1 990-94 accepters was 12.9% for pills, 2.0% for IUDs, 0.5% for injectables, 22.0% for condoms and 13.4% for 'other' methods (sampoon, foam, jelly and t raditional methods). For pills, condoms and 'other' methods, the likelihood of failure declined with the duration of use; by contrast, the probability of an IUD failure increased over time, peaking at 3 years of use. The inje ctables maintained a low likelihood of failure regardless of the duration o f use. The quality of Community Health Workers' (CHWs) performance was asso ciated with the risk of failure of all temporary methods except condoms; wo men's background characteristics associated with failure varied by method. The effect of the quality of the CHWs' performance and the background varia bles on failure did not change much over time. It is felt that contraceptiv e failure deserves the serious attention of programme managers and policy m akers to make the Bangladesh national family planning programme more succes sful.