DHS ANALYTICAL STUDIES 22 DHS ANALYTICAL THE IMPACT OF CONTRACEPTIVE FAILURE ON UNINTENDED BIRTHS AND INDUCED ABORTIONS: ESTIMATES AND STRATEGIES FOR REDUCTION THE IMPAC T OF C ON T RACEP TI VE DHS ANALYTICAL F A I LURE ON U N I STUDIES 22 N T ENDED B I R T HS AND INDUCED HS AB OR TI ONS: ONS: E S TI MA T ES AND ES ST RA T EG I ES FOR R EDUC TI ON SEPTEMBER 2011 This publication was produced for review by the United States Agency for International Development. It was prepared by Sarah E.K. Bradley, Trevor N. Croft, and Shea O. Rutstein of ICF Macro. MEASURE DHS assists countries worldwide in the collection and use of data to monitor and evaluate population, health, and nutrition programs. Additional information about the MEASURE DHS project can be obtained by contacting MEASURE DHS, ICF Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (telephone: 301-572-0200; fax: 301-572-0999; e-mail: [email protected]; internet: www.measuredhs.com). The main objectives of the MEASURE DHS project are: • to provide decisionmakers in survey countries with information useful for informed policy choices; • to expand the international population and health database; • to advance survey methodology; and • to develop in participating countries the skills and resources necessary to conduct high-quality demographic and health surveys. DHS Analytical Studies No. 22 The Impact of Contraceptive Failure on Unintended Births and Induced Abortions: Estimates and Strategies for Reduction Sarah E.K. Bradley Trevor N. Croft Shea O. Rutstein ICF Macro Calverton, Maryland, USA September 2011 Corresponding author: Sarah E.K. Bradley. Demographic and Health Research Division, ICF Macro, 11785 Beltsville Drive, Calverton, Maryland 20705, USA; Phone 301-572-0282; Fax 301-572-0999; Email: [email protected] Acknowledgements Parts of an earlier version of this paper were presented at the Population Association of America conference. We thank discussant Jane Menken and other conference participants for their feedback and suggestions. Thanks to Tom Pullum for his review and useful comments, and to Bryant Robey for his usual excellent edits. Special thanks to Kathryn Kost for a thoughtful, insightful review and helpful suggestions. Editor: Bryant Robey Document Production: Yuan Gu This study was carried out with support provided by the United States Agency for International Development (USAID) through the MEASURE DHS project (#GPO-C-00-08-00008-00). The views expressed are those of the authors and do not necessarily reflect the views of USAID or the United States Government. Recommended citation: Bradley, Sarah E.K., Trevor N. Croft, and Shea O. Rutstein. 2011. The Impact of Contraceptive Failure on Unintended Births and Induced Abortions: Estimates and Strategies for Reduction. DHS Analytical Studies No. 22. Calverton, Maryland, USA: ICF Macro. Contents List of Tables ................................................................................................................................. iv List of Figures ................................................................................................................................. v Preface ........................................................................................................................................... vii Executive Summary ....................................................................................................................... ix 1. Introduction ............................................................................................................................. 1 2. Data .......................................................................................................................................... 3 3. Methods ................................................................................................................................... 5 4. Results ..................................................................................................................................... 7 5. Limitations ............................................................................................................................. 28 6. Discussion and Conclusions .................................................................................................. 30 Methodological Appendix ............................................................................................................ 32 References ..................................................................................................................................... 39 iii List of Tables Table 1. Characteristics of sample and population, DHS surveys 2002-2010 ...........................5 Table 2. Percent distribution of all live births/pregnancies in the four-year period of observation by wantedness status/birth outcome, DHS surveys 2002-2010 ................8 Table 3. Among live births and pregnancies in the four-year period of observation by wantedness/termination status, percentage of each category that resulted from contraceptive failure, DHS surveys 2002-2010 .........................................................11 Table 4. Contraceptive prevalence among all/ever married women age 15-49 by method and country, DHS surveys 2002-2010 .......................................................................13 Table 5. First-year contraceptive failure rates by contraceptive methods, DHS surveys 2002-2010 ...................................................................................................................16 Table 6. First-year contraceptive failure rates by method type, DHS surveys 2002-2010 ......17 Table 7. Percentage of live births in the four-year period of observation by wantedness status, total and as a result of contraceptive failure, DHS surveys 2002-2010 ..........20 Table 8. Percentage of pregnancies that ended in induced abortion in the four-year period of observation, total and resulting from contraceptive failure, women age 15-49, DHS surveys with abortion data 2002-2007 ..............................................................21 Table 9. Percentage of unintended births that could be avoided by using more effective contraception, among women 15-49, DHS surveys 2002-2010 .................................24 Table 10. Number of unintended births that could be avoided per year by using more effective contraception among women 15-49, Countries with DHS surveys, 2002-2010 ...................................................................................................................26 Table 11. Percentage of induced abortions that could be avoided by using more effective contraception, among women 15-49, DHS surveys 2002-2007 .................................27 Table 12. Number of induced abortions that could be avoided per year by using more effective contraception among women 15-49, Countries with abortion data from DHS surveys, 2002-2007 ...........................................................................................28 Table A.1. Percent distribution of all live births/current pregnancies in the five years preceding the survey by wantedness status/birth outcome, DHS surveys 2002- 2010 ............................................................................................................................35 Table A.2. Among current pregnancies and live births by wantedness status, percentage of each category that resulted from contraceptive failure, DHS surveys 2002-2010 .....37 iv List of Figures Figure 1. Percentage of live births that were unintended, and percentage of all pregnancies that were terminated among women age 15-49 ............................................................9 Figure 2. Contraceptive method mix among women age 15-49 using contraception ...............14 Figure 3. Failure rates by month by contraceptive method .......................................................18 Figure 4. Failure rates by month by contraceptive method type ...............................................19 Figure 5. Method used at time of conception of unintended births ...........................................22 Figure 6. Method used at time of conception of pregnancy leading to abortion .......................23 v Preface One of the most significant contributions of the MEASURE DHS program is the creation of an internationally comparable body of data on the demographic and health characteristics of populations in developing countries. The DHS Comparative Reports series examines these data across countries in a comparative framework. The DHS Analytical Studies series focuses on analysis of specific topics. The principal objectives of both series are to provide information for policy formulation at the international level and to examine individual country results in an international context. While Comparative Reports are primarily descriptive, Analytical Studies comprise in-depth, focused studies on a variety of substantive topics. The studies are based on a variable number of data sets, depending on the topic being examined. A range of methodologies is used in these studies, including multivariate statistical techniques. The topics covered in Analytical Studies are selected by MEASURE DHS staff in conjunction with the U.S. Agency for International Development. It is anticipated that the DHS Analytical Studies will enhance the understanding of analysts and policymakers regarding significant issues in the fields of international population and health. Ann Way Project Director vii Executive Summary This study investigates