Today, more than a third of women not wanting to become pregnant stop using a contraceptive method within the first year of starting it, and more than half stop within two years. The numbers are even higher among young women. Of course, there are many women who do want children, with many even struggling and seeking the help of fertility financing so they are able to start a family. But, why do women and girls who do not want to become pregnant stop using contraceptives?

A report, “Contraceptive Discontinuation: Reasons, Challenges, and Solutions,” from Family Planning 2020 (FP2020) and Population Council, takes an in-depth look at reasons why women and girls stop using contraceptives, ways to reduce discontinuation and make it easy to switch methods, and measurement and monitoring of this phenomenon.

As FP2020 is now at the halfway mark, the global partnership seeks to accelerate efforts to reach 120 million more women and girls with access to rights-based family planning by 2020. Contraceptive discontinuation needs to be better understood if FP2020 is to achieve its goals

More than half of the women who stop using a particular method don’t want to become pregnant and still have need of effective contraception. Contraceptive discontinuation, the phenomenon of starting a contraceptive method and then stopping, can lead to unintended pregnancies if women are not stopping because they want to get pregnant or no longer need protection. In the words of Anrudh Jain, Distinguished Scholar at the Population Council, discontinuation is the “leaking bucket” that reduces the impact of family planning programs around the world if they do not support sustained and effective use of preferred methods.

There are several reasons why women may stop using a contraceptive method when they want protection against pregnancy. Some women stop using a particular method because it is difficult to use or its use is unacceptable to the woman or her partner (for example, due to side effects) and subsequently switch to another method-one that is more suitable to them and often more effective.

During our research, we found that the majority of women who discontinue for reasons other than wanting a child or no longer needing protection report that they do so due to “method-related concerns,” primarily meaning they have concerns about side effects such as abnormal bleeding.

Side effects may also have adverse sociocultural consequences. In some cases a woman stops using contraceptives when abnormal bleeding or spotting limits her ability to pray, prepare food, or have sexual relations, especially among women whose partner may not know she is using contraceptives. Misinformation–for example, the myth that contraceptives cause infertility or cancer-also contribute to discontinuation. Most women stop using contraceptives without consulting their health care provider.

In addition, between 7 and 27 percent of women stop using a contraceptive method for reasons related to the quality of service or care, availability of a variety of methods, lack of supplies, and ineffective referral systems.

We also found that young women have higher rates of contraceptive discontinuation than older women. Adolescents aged 15-19 years are more likely than women 20 years or older to have shorter periods of consistent use, higher use-failure rates (25% higher than older women) and a greater likelihood to discontinue using contraception for reasons other than pregnancy.

Reasons for discontinuation among adolescents may include stigmatization and provider bias that limits their access, resupply or ability to switch methods. There is also a poorer understanding and acceptance of side-effects of contraception, and married adolescents may face familial pressure to conceive soon after marriage.

This may have significant personal and societal consequences if discontinuation leads to unintended pregnancy, especially for countries whose young people are a large percentage of their population. High levels of adolescent fertility may prevent their participation in education and employment opportunities that are needed to achieve a demographic dividend-a boost in economic productivity that occurs when there are growing numbers of people in the workforce relative to the number of dependents.

In our report, we recommend various ways to reduce contraceptive discontinuation, including encouraging counseling about potential side effects, engaging male partners, dispelling misconceptions, increasing the number of methods available, improving follow-up services, and facilitating easier access to contraception.

While more women and girls than ever before are using contraception, there are still 225 million women who want family planning but lack access to it.

Ensuring that women and girls have quality, rights-based information, services and supplies is critical to reducing contraceptive discontinuation. If family planning programs do not enable all women and girls to continue to use contraception effectively, countries miss a vital opportunity to deliver on the promise of the Sustainable Development Goals, and particularly the goals of good health and well-being and gender equality.

For more information, please read “Contraceptive Discontinuation: Reasons, Challenges, and Solutions.”

July 11 marked the midpoint of Family Planning 2020 (FP2020), the global partnership that supports the rights of women and girls to decide, freely and for themselves, whether, when, and how many children they want to have. This blog is part of a series that looks at a key intervention to accelerate progress on our goal to enable an additional 120 million women and girls to use modern family planning methods: ensuring young people have the right to plan their families and their futures. We know that the ability to reach more young people with contraception in ways that speak to their own needs and desires is essential to achieving our goal by 2020, which is a critical milestone on the road to 2030 and providing universal access to family planning under the Sustainable Development Goals. For more information, visit www.familyplanning2020.org/midpoint.

Image: A female doctor discusses Family Planning Issues with women at Mchinji Hospital in Malawi where UNFPA provides support. UNFPA/Pirilani Semu-Banda.