Typical-use contraceptive failure rates in 43 countries with Demographic and Health Survey data: summary of a detailed report

Chelsea B. Polis, Sarah E.K. Bradley, Akinrinola Bankole, Tsuyoshi Onda, Trevor Croft, Susheela Singh

While most unintended pregnancies occur because couples do not use contraception, contraceptive failure is also an important underlying cause. However, few recent studies outside of the United States have estimated contraceptive failure rates, and most such studies have been restricted to married women, to a limited number of countries, and to 12-month failure rate estimates. Using self-reported data from 43 countries with Demographic and Health Survey (DHS) data, we estimated typical use contraceptive failure rates for seven contraceptive methods at 12, 24 and 36months of use. We provide a median estimate for each method across 43 countries overall, in seven subregions, and in individual countries. We assess differences by various demographic and socioeconomic characteristics. Estimates are not corrected for potential errors in retrospective reporting contraceptive use or potential underreporting of abortion, which may vary by country and subgroups within countries. Across all included countries, reported 12-month typical use failure rates were lowest for users of longer-acting methods such as implants (0.6 failures per 100 episodes of use), IUDs (1.4) and injectables (1.7); intermediate for users of short-term resupply methods such as oral contraceptive pills (5.5) and male condoms (5.4); and highest for users of traditional methods such as withdrawal (13.4) or periodic abstinence (13.9), a group largely using calendar rhythm. Our findings help to highlight those methods, subregions, and population groups that may be in need of particular attention for improvements in policies and programs to address higher contraceptive failure rates.