Twenty-four-month continuation of reversible contraception

Abstract

Objective: To estimate 24-month continuation rates of all reversible contraceptive methods for women enrolled in the Contraceptive CHOICE Project.

Methods: We analyzed 24-month data from the 9,256 participants enrolled in the Contraceptive CHOICE Project, a prospective observational cohort study that provides no-cost contraception to women in the St. Louis region. The project promoted the use of long-acting reversible contraception (LARC) (intrauterine devices [IUDs] and implants) in an effort to reduce the rates of unintended pregnancy. This analysis includes participants who received their baseline contraceptive method within 3 months of enrollment and who completed a 24-month follow-up survey (N=6,153).

Results: Twenty-four month continuation rates for long-acting reversible contraception and non-LARC methods were 77% and 41%, respectively. Continuation rates for the levonorgestrel and the copper IUDs were similar (79% compared with 77%), whereas the implant continuation rate was significantly lower (69%, P<.001) compared with IUDs at 24 months. There was no statistically significant difference in 24-month continuation rates among the four non-LARC methods (oral contraceptive pill [OCP] 43%, patch 40%, ring 41%, depot medroxyprogesterone acetate [DMPA] 38%; P=.72). Participants who chose a LARC method at enrollment were at significantly lower risk of contraceptive method discontinuation (adjusted hazard ratio 0.29, 95% confidence interval 0.26-0.32) compared with women who selected a non-LARC method.

Conclusion: Intrauterine devices and the implant have the highest rates of continuation at 24 months. Given their effectiveness and high continuation rates, IUDs and implants should be first-line contraceptive options and shorter-acting methods such as OCPs, patch, ring, and DMPA should be second tier.

Level of evidence: II.

Conflict of interest statement

Financial Disclosure

The other authors did not report any potential conflicts of interest.

Figures

Figure 1

Contraceptive CHOICE Project Participants Eligible for 1 Examination of 24 Month Continuation

Figure 2

Continuation Over 24 Months for long-acting reversible contraceptive LARC (A) and non-long acting reversible contraceptive non-LARC(B) methods. Log rank P-value=0.72. Levonorgestrel intrauterine system (LNG IUS; copper intrauterine system (IUD); oral contraceptive pill (OCP); depot medroxyprogesterone acetate (DMPA).