Page 1
CONT AND RETEI SURV SRI L
613•9 F HB
FAMILY H MINISTRY

FINUATION
VTION RATE EY-1985 ANKA
INE
EALTH BUREAU
OF HEALTH

Page 2
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་ ་ ་ ་ ན་ ་ ད་ པ་
༣ .
£|:* - ,

Page 3
CONTINUATION AND RET
SRI LANKA
June 1986.

评:,如美國。
E
637
E.G. 585
| RIC:
ENTION RATE SURVEY 1. 1985
|L135.
FHT
CLASS
NO.
ACCN.
NO.
Evaluation Unit, Family Health Bureau, 231, De Saram Place, Colombo-10. SRI LANKA.

Page 4
ТЯ СИА ИoТАШиfТИo2
23 НИК
че е
14
.

- мнѣ над
YayЯUг ЗХАЯ ИОТИЗ
Ве. А
Рун
Мае.
itira
на 4 гадаад ознакама:
and
(
it to guist3 useud ib!ssН lirsi goslЯ Тs162 33 .TES
0-odrolo. АХИАД 1:2

Page 5
C O N T B
Preface.
Acknowledgement.
List of Tables
CHAPTER 1
The Study
CHAPTER 2
Continuation a Oral Contracep
CHAPTER 3
Discontinuatio Oral Contrace
CHAPTER 4
Selection, Mot Counselling fo Oral contracep
CHAPTER 5
Summary and Co
Appendix.

N TS
Page
und Retention Rates of -tives & IUCD
-n of IUCD and =ptive
- = 2 & 3
-ivation and -r 1UCD & -tive
onclusion

Page 6
ਨ ..
| ,ਤੇ
ਆ, .
.
... ਨੂੰ ਤੇ
*
ਹੋ 7 ਤੋਂ ?
ਹੈ

8 :
:
ws
ਹੈ .
= : ਲ
* * * *

Page 7
PREFAC
This is a third in a Retention Rate Surveys conducted The results of the first and : 1977 and 1979 had not been pu results were used for purpose
The present survey dea of the oral pill and the IUCD. rates of the injectable contrac ferred till 1988, since this met only since 1985.
The results of this derived are most timely in view ssed in Sri Lanka regarding the ary modern methods of contracepti
I am sure the finding only be of use to us in Sri L interest to programme managers of
Family Health Bureau, 231, De Saram Place, Colombo 10.

CLASS
NO.
ACCN.
NO.
series of Continuation and by the Family Health Bureau. second surveys conducted in blished though some of the
of programme evaluation.
als with the pattern of use
A study on the continuation ceptive (DMPA) has been dehod was available islandwide
survey and the conclusions of the concerns being exprelevel of use of the temporon.
Is of this study would not anka, but also would be of
other countries.
Dr. N.W. Vidyasagara Director (Maternal and
Child Health) Ministry of Health.

Page 8
:5 ਤੋਂ
ਚs s
E0.

ਯੂ , ੪ : 3
ਰੂ
ਨੂੰ ਚ
ਹੋ ਰਹੀ ਹੈ
ਤੀਰ ਹੈ ਤੇ ਪੈਗ
ਦੇ 1 ਤੋ' 3 ਤ
ਘ... C , ਰੂ
ਨੂੰ ਵੀ ਮੈ -
( ) ,* ** *)
134)

Page 9
ACKNOWLEI
Several institutions and per implementation of the Continuation a by the Family Health Bureau during 198.
Our thanks are due to the I Dr. K.H. Notaney - WHO Programme Coo Lanka for the valuable assistance pa the study.
I wish to thank Dr. S.D.M. F Services and Dr. M. Rodrigo Deputy D their encouragement and cooperation ext
A very special word of thank gara Director (MCH) for the administrat provided throughout the study.
Officers of the Medical/Healt th Midwives Areas that were selected f cooperation during the sample selection rs who helped the study team in numerou
The members of the study te for their untiring efforts and their it would not have been possible to specially commend the interviewers (Pt difficult task of carrying through considerable personal hardship.
Last but not least I exten respondents of the study for their o directly or indirectly participated o connected with the survey.
Evaluation Unit, Family Health Bureau, 231, De Saram Place, Colombo 10.

PGEMENT
sonnel contributed to the successful nd Retention Rates Study conducted 4/85.
UNFPA for funding the study and to rdinator and Representative in Sri Covided during different stages of
Fernando, Director General of Health irector Public Health Services for cended during the study. 10
Es is extended to Dr. N.W. Vidyasaive support and technical expertise
ch Institutions and the Public Healor the study extended their fullest 1. I wish to thank all those officeis ways during sample selection.
2am deserve a special commendation
expertise provided without which conduct this study. I must also Iblic Health Midwives) who had the the interviews often undergoing
1 my gratitude and thanks to the :ooperation and to all others who contributed to various activities
DI. K. P. Wickramasuriya
Project Manager

Page 10
LIST OF
THE S
1.1. Distribution of Respondents 1.2. Main Reasons for loss to follow I 1.3. Percentage Distribution of sample
Age Group 1.4.
Percentage Distribution of san
the number of living children 1.5. Percentage Distribution of sam
Education 1.6. Percentage Distribution of sampl
of Employment 1.7.
Percentage Distribution of sam Ethnicity
CONTINUATION AND RETE
CONTRACEPTIVES
2.1. Distribution of Respondents 2.2.
Continuation and Retention Rate Contraceptives and IUCD by Or
commencement of use 2.3.
Retention Rate of IUCD according
Duration of Use 2.4.
Retention Rate of IUCD according
Children and Duration of use. 2.5.
Retention Rates of IUCD accor
Education and Duration of use. 2.6.
Continuation Rates of Oral Conti
to Age Groups and Duration of use 2.7
Continuation Rates of Oral Conti
to Number of Living Children ar 2.8. Continuation Rates of Oral Contı
to Levels of Education and Dur

TABLES
-TUDY
Page
up.
e according to
nple according to
no to
o o o un w w
nple according to
te according to Type
nple according to
ENTION RATES OF ORAL
S AND IUCD
s of Oral -dinal Months after
g to Age Groups and
to Number of Living
ding to levels of
= a a G = = = =
raceptives according
raceptives according nd Duration of use. raceptives according ration of Use.

Page 11
DISCONTINUATION OF IUCD ANI
3.1. Distribution of Respondents • 3.2. Net Cumulative Termination Rate
Contraceptives 3.3. Cumulative Termination of IUCD per 1
to Type of Discontinuation 3.4. Percentage Distribution of Disc
Removal of the IUCD 3.5. Main reasons for removal of IUCD acc
of use 3.6. Sterilization among IUCD Discontinu
Time of Termination and Number of 3.7. Percentage Distribution of disco
Contraceptives 3.8. Percentage Distribution, of discontinu
according to Reasons and Time of Te 3.9. Distribution of Discontinuers of
Contraceptives according to Level
SELECTION, MOTIVATION AND COUNS
CONTRACEPTI
4.1. Distribution of Acceptor Respo
Reasons for Selection of Method 4.2. Distribution according to Motivati 4.3. Distribution of Respondents accord
providing advice
SUMMARY AND CO. 5.1. Continuation and Retention Rates o
tives and IUCD.

ORAL CONTRACEPTIVES
Page
19
of IUCD and Oral
00 women according
23.
continuers due to
ording to Duration
uers according to - Living children ntinuers of Oral
26
ners of Oral Pill rmination f IUCD and Oral s of Education.
28
ELLING FOR IUCD AND ORAL EVE.
nses according to
i on Personnel ding to Person
2 * 5. *
NCLUSION f Oral Contracep

Page 12
MAP OF SRI LA
0 JAAF AAA
OOK EUREN
MANNAR
ANURADHAPURA
PUTTALAM
KURUNE GALA
V \
( KEGALLE GAMPAHA
COLOMBO
ELI
KALUTARA
RATNAPI
GALLE
MATARA

NKA SHOWING ADMINISTRATIVE DISTRICTS
District Boundary
Areas excluded from study
POLONNARUWA
TATALE
V ANDY
P-ARA:
S BADULLA
YA
MO NE RAGALA
JRA
ΗΑΜΒΑΝΤΟΤΑ

Page 13
CHAPTER THE STUI
Routine family planning statisi only on New Acceptors of family plannir duration of use of Temporary Modern Met the routine reporting system. Some studi in Sri Lanka many years ago, but there available on continued use of Temporary Me
The last study on this subject wi Bureau in 1979 but the findings had not results were used for evaluating service f
The present study provides data Intra uterine Contraceptive Device (IUC addition, the study has also collected i graphic characteristics of users of the for discontinuation.
METHODOLOGY
The sample was selected from acce tives during the period - 1st of Januar multistage technique based on probabil adopted for selection of the sampling unit
SELECTION OF SAMPLE
The sample was selected based
1st Stage : The country was st
to provinces. Of and Eastern pro operational constr result of the rec The study was th provinces of the c
A disertai

Cics in Sri Lanka provides data ng by method. Information on the Chods is not provided for within es in this field were undertaken after very little information is odern Methods of Contraception.
as undertaken by the Family Health been published though some of the performance.
on the duration of use of the D) and Oral contraceptive. In nformation on certain socio-demose methods and the main reasons
eptors of IUCD and Oral Contracep'y 1982 to 31st of July 1984. A ity proportionate to size, was
S.
on a stratified 3 stage design.
ratified into co-strata according
the 9 provinces, the Northern vinces were excluded due to 'aints in data collection as a ent disturbances in the country. erefore limited to the other 7 vuntry.

Page 14
Within ead grouped to tors of IU Division. size, the units were
SA SE
2nd Stage : The number
according .
selected H tema se
had report during the ling frame the Health probability secondary S
Each Healt The Health clinic ceni for the se tives. Th certain ope tion.
3rd Stage : From each
from among 1st Januar was selecti 15 cases f year maint tres were i Each Healt Midwife ar secondary Midwife ( PHM areas
1.
The Seven Provinces are di charge of a Regional Directo
2

1 province the Health Divisions' were ether and the total number of new accep:D and orals listed according to Health lased on probability proportionate to lealth Divisions as first stage sampling
selected using random number tables.
of new acceptors of IUCD were stratified to the IUCD clinic centres within the !alth Division. Only those clinics which :d a minimum of 15 IUCD cases each year
study period were included in the samp. Two IUCD clinic centres from each of
Divisions were then selected based on ' proportionate to size - providing the
ampling unit.
1 Division is divided into Health Areas.
Areas that corresponded to the IUCD tres became the secondary sampling units lection of acceptors of oral contracepis procedure was adopted to overcome erational constraints during data collec
IUCD clinic centre, the sample was drawn
the IUCD acceptors recruited between y 1982 to 31st July 1984. The sample ed based on systematic sampling to obtain or each year. The F.P. Records for each ained at each of the selected clinic cenused for this purpose.
Area is subdivided into Public Health eas. For oral contraceptive users, the sampling units were the Public Health HM) areas within the MOH areas. Three were randomly selected from each of the
vided into 15 Health Divisions each in - of Health Services (RDHS).

Page 15
selected Health were selected f selection with study. The fami used as the samp
antes
antes de la
The same proced the sample froi of Sri Lanka.
SAMPLE SIZE
va Using the above sampling proce
selected for each method, so that a m method could be located.
e a po
A During fiela operations, 552 a of orals were located and relevant data
TABLE
Distribution of
Number of Acceptors selected
Number Interviewed
Number lost to follow up
Coverage
The main reasons for loss to follov
TABLE 1 Main Reasons for Lo
au
Reasons
Num
Incorrect Address Not residing in the area ET
9,
Could not be contacted at
time of survey
Left the country
ES TRE Other reasons
08
Total
258

Areas and five acceptors of orals or each study year using systematic
a random start for the period of ly planning records of the PHM were -ling frame.
dure was adopted for selection of m the Family Planning Association
dure, a total of 810 acceptors were inimum of 500 respondents for each
acceptors of IUCD and 507 acceptors
collected.
|
1:1
Respondents
negara A
IUCD
Oral Contraceptives
810
810
|(552
507
552 258
a 258
303
68, 19
62.6%
12F
1 M
v up are illustrated in Table 1.2. 1.2
Ss to Follow up
IUCD nber
Oral Contraceptive Number
7.0
-
35.3
| 128 | 42.2
128
42.2
35.3
100
33.0
19.4
26
8.6
3.0
16.2
100.0
303
100.0

Page 16
DATA COLLECTION
Data was collected in the Public Health Midwives (PHMS ), us teams were given a 4 day-training tering the questionnaire and their ment of field operations.
The teams were provided wi med to cover the selected areas Periodic supervision and guidance the staff of the Evaluation Unit at
Data collection commenced a period of three months. In the the IUCD at the time of the survey, the team members to confirm the pre
QUESTIONNAIRE DESIGN
A pre-coded questionnair information was collected in respec
i) Socio Demographic Cha ii) Period of use of Cont iii) Reasons for Accepting iv) Reasons for discontin
v) Side-effects vi) Follow up visits
DATA PROCESSING
The completed interview ! Family Health Bureau according to and coding procedures.
Data was processed using (ICL Micro Processor - Model 8120 software developed by the Evaluatio
CeSSO
Thereafter data was anal table techniques and statistical me

homes of the respondents, by six trained ng a structured questionnaire. The PHM at the Family Health Bureau on adminisability was pre-tested prior to commence
th transport and their work was programaccording to a pre-arranged schedule. was available throughout the survey by the Family Health Bureau.
in mid November 1984 and continued for case of respondents who were still using
a vaginal examination was performed by sence of the IUCD.
ve was used for data collection and t of:
racteristics of Respondents raceptive Method
the Method uation of method
schedules were edited and coded at the
pre-determined editing specifications
1 electronic data processing equipment /12) at the Family Health Bureau with n Unit.
ysed using applications based on life thods.

Page 17
THE SAMPLE POPULATION
In this study the sample cons group 15 - 49 years who had accepted € method of contraception during the tim July 1984. A total of 552 and 507 ac respectively were interviewed and their analysed.
These characteristics were com racteristics of all new acceptors recruit 1983 in order to establish representat
ERAS
TABLE 1 Percentage Distribution of
Age Gro
Age Group
IUCD Acce Sample Tot
fo
15 - 19
2.5
31.4
! !!!
$ $ $
28.4
21.3
11.4
35 - 39 40 - 44 45 - 49
4.8
0.2
Unspecified
Total
100.0
552
| 16
Total number of Acceptors
The majority of respondents of I 20-24 and 25-29 years. 59.8% of the Iud were from these age groups. This is illus

isted of married women in the age either the IUCD or Oral Pill as a me frame 1st January 1982 to 31st ceptors of the IUCD and Oral Pill - socio-demographic characteristics
pared with the corresponding chaced by the national programme during tiveness of the selected sample.
- Sample According to oup
eptors tal Acceptors I 1983
Oral Pill Acceptors Sample Total Accaptors
for 1983
6.3 38.0 28.9
2.3
31.2
5.5 35.0
32.3
30.8
17.2
18.6
22.5 10.5 2.7
6.9 1.9
6.6
1.5
0.4
0.3
0.4
0.2
100.0
100.0
100.0
5,328
507
33,821
both methods were in the age groups CD and 62.0% of oral pill acceptors
trated in Table 1.3.

Page 18
It is worthy of note tha recruited by the National Programm phic characteristics as the study distribution according to the numbe
Percentage Distribut
a bado
the Number o
Number of Living Children
Sample
u N
19.7 39.1 23.8
S
9.6
5
3.9
6 & above
3.9
Unspecified
Total
100.0
Total Number of Acceptors
552
The proportion of study re the number of living children, show categories) from those of the total when grouped under two broad catego and four or more than 4 chilaren, that of the total acceptors recruit.

t the acceptors of oral pill and IUCD
had a similar pattern of socio demograsample. Table 1.4. illustrates the sample r of living children.
IBLE 1.4
- S - -
ion of Sample According to
F Living Children
CD Acceptors
Total Acceptors for 1983
Oral Pill Acceptors Sample
Total Acceptors for 1983
23.7
31.9
28.2 36.6 19.4 8.6
23.9
31.0 32.4 17.9 8.8
4,3 4.1
10.3
3.5
5.2 5.0
3.1 0.6
1.5
100.0
100.0
100.0
16,328
507
33,821
busier
spondents when categorised according to ed a certain variation (within individual
acceptors recruited during 1983. However ries namely three or less than 3 children the samples proportions were similar to ed by the programme during 1983.

Page 19
Table 1.5 illustrates the s educational level.
TABLE 1 Percentage Distribution
to Educa
Level of Education
IUCD Acce Sample
Toti for
4.0
32.1
44.5
No Schooling Grades 1-5 Grades 6-9 GCE 'O' Level GCE 'A' Level and above Unspecified
17.1
N = N N n
2.3
Total
100.0
100
Total Number of
Acceptors
552
16,1
* Data on New Acceptors recruited by the Nation is avai lable only after 1984.
4.0% of IUCD and 5.7% of oral sample had not been to school. The maj primary or secondary level educati Oral Pill acceptors were in this gr levels of Education was seen among accept ed by the programme during 1984.
The similarities between the s recruited by the national programme woul tiveness of the sample and the study pop
ESS

ample distribution according to
1.5
of Samples according tion
eptors
al Acceptors
Oral Pill Acceptors Sample Total Acceptors
for 1984*
1984*
2.4
2.9 5.6
26.1
5.7.
5.7
26.6 42.1 22.4 3.2
51.5
1.6
16.2 1.0 2.8
-.0
|100.0
100.0
40
507
32,895
al Programme according to level of education
pill acceptors in the selected brity of the respondents had either ion. 76.6% of IUCD and 68.7% of 'oup. A similar pattern in the :ors of IUCD and Oral Pills recruit
elected sample and total acceptors a indicate a reasonable representalation.
7

Page 20
GENERAL CHARACTERISTICS OF THE SAM
Distribution of resp is illustrated in Table 1.6.
Percentage Di according to
Employment
Not employed (housewife)
Casual labourers
Labourers
Owner cultivators
Estate Worker
Office worker Professionals/
Technicians
Others
Total
Total number of
Acceptors
Majority of the res the survey, the proportions being acceptors. Casual labourers accoul pill acceptors. The other emplo

LE POPULATION
ndents according to type of employment
BLE 1.6.
stribution of Sample Type of Employment
IUCD Acceptors
Orai Pill Acceptors
87.5
89.3
5.9
2.5
0.9
0.8
0.9
1.7
0.2
0.7
0,4
4.1
5.1
100.0
100.0
552
507
pondents were not employed at the time of
87.5% for IUCD and 89.3% for Oral Pill ated for 5.9% of IUCD and 2.5% of oral yment categories were almost negligible.
SEE -

Page 21
TABLE 1
Percentage Distributi
according to
IUCD Acce
plus nomes
Ethnicity
Sample
To
fo
Sinhalese
96.1
Sri Lankan Tamils
0.5
Indian Tamils
0.0
Moors
3.2
Others
0.2
Total
100.0
Total Number of
Acceptors
552
Distribution of respondents a that 96.1% of IUCD acceptors and 96.6% of Sri Lanka Tamils comprised 0.5% of IUCI while Moors accounted for 3.2 and 1.1% respectively.
The sample is observed to be be due to the exclusion of the Northern a where the minority ethnic groups predomia of new acceptors of IUCD and Oral pills during 1983 and the proportion of IUCD a have shown a similar ethnic composition.

1.7
ion of the Sample
Ethnicity
ptors
Oral Pill Acceptors
tal Acceptors
Sample Total Acceptors
for 1983
r 1983
90.7
5.8 0.5
96.6 1.3
87.4
6.1
0.0
0.3
2.8
1.1
5.7
0.2
1.0
0.5
100.0
|100.0
|100.0
16, 328
507.
33,821
ccording to ethnicity illustrated
oral pill acceptors were Sinhalese.
and 1.3% of Oral Pill acceptors - of IUCD and oral pill
acceptors
predominantly Sinhalese. This may und Eastern provinces from the survey nantly live. However the proportion
recruited by the National Programme und Oral Pill acceptors in the study

Page 22
੬ ਚ ਨੂੰ ਵੀ ਦੂਰ ਹੈ 21. ਹੈ ਕਿ ਦੋਵੇਂ ...
ਕੀ ਹੈ ਤੇ .
ਨ: "
***
, Pi »
ਤਾਂ
ਜੇ.
ਘਦੇ ਨੇ ? ਏ ਤੇ ਉ ਊ ਦੇ ਸੈਨਾ ..
:: ਹੋ : : . ਨੂੰ $ cਰੂ ਦੇ
.
ਨੂੰ
4 .
ਰੂ
ਆਂ
, , ,

ਲੱਖ -
ਕੇ ਦੇ
--
ਬਾਕੀ ਦੇ .
* 45 Tw
... ਕੀ 1-: -
ਨੂੰ ਦੇ ਕੇ ਨੂੰ ਤੇ
ਦੇ.
ਆ " " " " " " .
ਦੇ ਦੇ 'ਚ 1 ਦੀ 111-184: ਜੋ
ਹਾਕਮ * ਦਾ , * * -- - Mgਆਂ 'le t 1 ---
ਜੀ ਦਾ 71
18)
233. ਦਰਨਾ ਵਾ , ਤੇ .
ਜੋ * *
. .
11t
ਨੂੰ
/ ॥
* ' '
:
ਦੇ / ਦੇ .
1r.
44. *
ਰਾ
5 , 3 . ਨੂੰ ਆਏ ਨੂੰ ਨੇੜੇ ਹੋਰ
ਦੇ ਨੂੰ ਵਿੱਤ ਵਿੱਚ .
ਤੇ ਤੇ 5 ਨੂੰ ਤੋਂ ਤੇ ਹੈ : =
ਹੈ * *

Page 23
CHAPTER
CONTINUATION AND RET
ORAL CONTRACEPTIV
In this study the ordinal mont date of commencement of the method (IUCD tion or from the 'cut off' date which-e for the study was taken as 31st July 19 been limited to the first segment of us between the commencement of the method commencement of the method and the cu
This chapter deals with contin contraceptives and IUCD. A sample of 81 acceptors were selected for the study. tors and 507 pill acceptors were identi information was collected.
TABLE 2. Distribution of I
Respondents
Total Respondents Number using at time of survey
Number of cases where vaginal examinations were performed
At the time of data collection the IUCD and .248 were continuing to use time of the survey was checked by a va was obtained in respect of 78.6% of IUCD tive result at vaginal examination were further follow-up.
a Table 2.2 illustrates the cont oral contraceptives and the IUCD per 100 dures. In constructing the life table f retention rates, the multiple decremen the method are described in appendix I. of this method has been checked with t by Dr. Christopher Tietze and the resu

2
'ENTION RATES OF
PES AND IUCD
Eh was obtained by subtracting the
or Pil1) from the date of terminaever was earlier. The cut-off date 984. Also the analysis of data has se. This consisted of the interval
and the first termination or the t-off date whichever was earlier.
uation and retention rates of oral 10 IUCD acceptors and 810 oral pill of the total sample 552 IUCD accepfied in the field and the relevant
Respondents
IUCD
Pill
552
507
383
248
301
- 383 respondents were still using the pill.. The use of the IUCD at the ginal examination and confirmation
users. Respondents showing a negae referred to the F.P. clinic for
tinuation and retention rates for
acceptors using life table proceor calculation of continuation and t method was adopted. Details of - The results obtained by the use _he life table technique developed alts were found to be identical.
11

Page 24
Continuation and Retentic and IUCD by. Ordinal Mor
Ordinal Months after commencement of use
The study revealed that ti than the oral contraceptive.
Both the Oral Contracept cline during the first three month of 75.1% and 88.9% respectively i both methods showed a slower decl 73.3% for Oral Contraceptives and The continuation rate for oral o low level of 27.6% while the ret
These observations clearly is used for a longer period of tim of protection than the oral contra

BLE 2.2. n Rates for Oral Contraceptives ths after commencement of use.
Continuation and Retention Rates
Oral Contraceptive
IUCD
91.0
95.3
75.1
88.9
60.6
82.5
54.2
75.6
52.9
73.3
43.3
42.9
42.3
62.3 62.3 61,7. 61.7 47.7
42.3
27.6
27.6
47.7
he IUCD had a higher rate of continuation
ive and the IUCD showed the fastest deas recording continuation/retention rates at the end of three months. Thereafter ine with continuation rates of 52.9% and
IUCD respectively at the end of 1 year. contraceptives after 2 years dropped to ention rate for IUCD remained at 47.7%.
- indicate that the IUCD once accepted e, thereby providing greater couple years ceptive.

Page 25
:, .
| ਕਈ
Figure | CUMULATIVE CO
Rate
|
100)
802
60 .
40
ਤੋਂ ਕਰ ਰਹੀ ਹੈ ਜਾ ਕਉD
207
, ਮਨ ਦੇ

... .
ਨੂੰ.
= ਇਸ ਨੂੰ
ONTINUATION RATE
ਨੂੰ ,
ਤ ਨੂੰ \Loop
Loop
Oral
24 .
30
Months
ਹੈ, ਉਸ ਨੂੰ
ਤੋਂ ਤੋਂ ਦੇ
13

Page 26
Some of the important socio-demo differentials in the pattern of o tives and IUCD was studied.
Retention Rate of IU
and Du
Age Group
Below 25 years
95.3
25-34 years
94.2
Above 35 years
97.7
When classified according differentials in the retention rat Retention rates were significantly 35 years of age suggesting that gr by women in these groups.
Bani Influence of living children on Ret
Retention Rates of IUCD
Children ar
Number of Living Children
0-3
96.0
4+
94.0
* A proportion test at 0.05 level ficant difference is commented upo
14

graphic variables that could influence ontinuation/retention of oral contracep-.
BLE 2.3
CD according to Age Groups
'ation of use
Duration in months
9 | 12 | 18 | 24 | 30
3
91.0
77.2
71.2
71.1
64.5
84.7 79.1 88.5
74.2
70.0
71.1
61.2
86.5 92.2
50,1
62.2
79.6
87.1
83.5
79.6
63.9
I to the above age groups, significant* es were recorded between the age groups.
· high in women below 25 years and above 'eater contraceptive protection is sought
tention of IUCD ABLE 2.4
according to Number of Living
ad Duration of use
Duration in Months
3 | 6
9 | 12
12
18
24
30
88.0 | 83.0
74.1
62.0
61.0
145.4
76.0 21.0
92.0 L81.0
70.0
66.2
66.2
57.1
of significance is used wherever a signi
n.

Page 27
The retention rates catego living children (grouped into 0-3 and feature. The retention rates for IUCE less than three children upto end of f not significant but thereafter the patt tion rates recorded for women with 4 o difference being recorded at 30 months.
Influence of Education on Retention of I
TABLE 2
Retention Rates of IUCD accordi
leg Sergei
and Duration
Dura
Level of Education
90.9
No Schooling Grades 1-5 Grades 6 & above
90.9 95.5 95.2
89.9
87.9
When classified according that education has had no significant

prized according to the number of 4 & above) reveals an interesting
is higher among women with 3 or irst year though the difference is cern is reversed with higher retenr more children with a significant
UCD
E MEST
2.5.
ing to levels of Education
of use a Do Sorong og
EN LAS
tion in months
12
| 18
30
90.9
90.9
84.8
un o
81.3
74,5
58.7 58.7 135.2 59.5
59.5
46.0 65.5 64.6
51.2
82.6
76.5
74.4
to levels of education it appears influence on retention of IUCD.
GA
15

Page 28
ART
Influence of Age on Conti ENTSTANDENÝ SON OTOT EN MET E TAB
SOM NON 1991 Continuation Rates of Ora
Age Groups an
Age Group
Below 25
93.4
25 - 34
90.0
35+
87.5
The continuation r groups indicated that the rates ar years and above 35 years of age e A similar pattern was observed with contraceptive protection is sought t
Influence of living children on
TAB
Continuation Rates of Ora
Number of Living Chi 26 Ma ei
No. of Living
Children
0-3 4 & above
91.8 7. 88.2 |7
16

luation of Oral Contraceptives
LE 2.6. ESTE CON LAS
der B 25 26 1 Contraceptives According to an
Deel in d Duration of use
Die eerste
12
Duration in months
12 || 18 || 24 |30
18
30 13.4 64.9 | 54.5 | 53.6 43.1 | 41.4 31.0 13.4
53.6 43.1
41.4
31.0
57.2
52.6
51.1
|39.5
39.5
|23,7 18.5 | 65.1 | 58,8 18.5
58.8
58.8
149.3
49.3
24.7
64,9
54,5
14.5
65.1
ates calculated for the different age se relatively higher in women below 25 specially at 24 months & 30 months.
the IUCD and would suggest that greater y Women in these age groups. Sa
| continuation of Oral Contraceptives
- Dent
ELE 2.7.
Mines
1 Contraceptives according to Idren and Duration of Use
Duration in months
9
12
18
30
161.7 1.9 54.8
55.6 48.4
44.8 | 48.4
43.8 39.5
43.8 39.5
41.4 22.8

Page 29
The continuation rates categorized accor ren (grouped into 0 to 3 & 4 and at significant difference between the numbe tion of use upto 24 months. Thereafter t cantly higher for women with 0 to 3 chilo
Influence of Education on Continuat
TABLE 2
Continuation Rates of Oral Con
Levels of Education an
Level of Education
74.5
No Schooling Grade 1-5
100
89.0
72,3
Grade 6+
91,3
74.4
The continuation rates indicated that E cant influence on the use of orals. How observed between the categories of no-s months.
Expectation of the duration of use was formula. The expected duration of use i and 3.5 years for IUCD.
1. R(t) = ae -rt. a is the pro
| |+ |-
r is the mo t is the time e is the base R (t) is the p
Pill accep at the end
Reference: Life Table Retention Rates, Re
on conversion factor of IUCDs
Lin, P.I., L.P. Chow & H. Abbe by Curve Fitting'. Demography

ielas
NO. 585
CLASS 1 13:9 CLASS
NO.
ACCN.
NO. ding to the number of living childpove) indicated that there is no er of living children and the durahe continuation rates were signifiDren.
sion of the Oral Contraceptive
-8
atraceptives According to d Duration of Use
Duration in Months
6 | 9 | 12 | 18 | 24 30
12
18
24
30
61.3
50.8
50.8
19.7
19.7
· 54.8
47.9
47.9 36.9
36.9
27.3
63.3
58.6
46.0 144.6
29.5
29.5
|39.5
ducation did not bear any signifiever a significant difference was schooling and grades 1 to 5 at 24
calculated according to Mauldins s 1.8 years for Oral Contraception
|
portion retaining after the
"immediate drop out" nthly probability of terminating
(in months) of natural logritham roportion of a cohort of IUCD/Oral otors who are still retaining it
of time t.
tention Function and Oral Pills PDH - 11.7
y 'A Study on IUD Retention , Vol. 9, No.1. Feb. 1972.

Page 30
ਲਾ/314
ਮਤੇ ਵੀ
4 .
| - ਜੋ ਚ n , 0 ਤੋਂ
-- , ੩ 3
5 ਨੂੰ ਤੇ ਤੋਂ ਜੋ ?
ਉਨ੍ਹਾਂ ਨੂੰ ਦੇ ਕੇ ਮੌਤ ਹੈ
ਜੋ ਮੈਂ ਲੋਡ 'ਚ ਵੱਲੋਂ ਤੇਰੇ ਤੇ
|
- *
ਗਲ ਲਗ ਕੇ,
ਦੀ ਕੀ ਹੈ , ਦੇ ਚ' : ਹੈ
ਹੈ ਤੇ ਇਸ
7 ਨੂੰ
- ਨਾ ਆ ਆ ਕਿ 1 2 ਤ ਛੱਡ ਕੇ ' % c .
ਘ, ਸ. ਤੇ
| ਜੋ ਤੇ Au ੧ ॥
ਤੋਂ 2 3 4 ਤੋਂ
ਪ
- ਬ5 ਆ ਤੇ b
ਖੋਜੋ 5 ਨੂੰ ੩ ?
ਦੇ .. ਦੇ ..

t
3 ਨੂੰ ਉਨ੍ਹਾਂ ਨੇ ਜੋ ਵੀ ਤੇ ਖੇ.
ਨੂੰ ਨੂੰ ਵੀ ਤਾਂ " ਤੇ ਨੂੰ ਹੋ ਕੇ ਕਿਤੇ ਵੀ ਹੋ (ਵ ਤੋਂ : ਹੈ। ਹੇ ਨੂੰ ਤੇ , ਉਦੋਂ ਤੋਂ .
1 "
ਤੋਂ ਲੈ ਕੇ ਰੋ ਹੋ ਹੋ
ਖੇਡ ਵੀ ਰੋ ਰੋ ਕਿ ਵਿੱਕ ਹੈ, 3 ਨੂੰ .
ਹੈ
........
= ਨੂੰ, " ਓ f
1 ਵਿੱਚ ਹੈ ਤੇ ਨਿ
ਏ ... " ਤੇ
3 , ਪਰ ਮੈਂ ਨ .
.. ਤੇ ਜਮ ਕੇ .13
:: E ਨੂੰ .
ਕਦੇ
- . ਹੈ 3 ਨੂੰ : ਹੈ : ੩
" Mtz
. . . . ... . .. - ਸਰ, 1 2 ਨੂੰ
w y

Page 31
CHAPTER DISCONTINUATION OF IUCD AN Data collected on certain aspects of di Loop) and Oral Pill were analysed to de each method using the multiple decrement
Of the total sample of 552 IUCD acceptor respectively had discontinued the IUCD the survey.
TABLE 3
Distribution of I
Respondents
Total Respondents
Number discontinued at time of survey
Percent discontinued
The net cumulative termination rates are
TABLE 3.
Net Cumulative Terminati
Oral Contract
Net Cumulative Ter
Ordinal Month After Commencement
IUCD
4,7
11.1
E N N N u o w
17.5 24,4 26,7 37.7
37.7
38.3
38,3
52,3
52.3
*
Upto 1984, the IUCD used through ou Thereafter the Copper Multiload 250 into the National Programme.

_3
ID ORAL CONTRACEPTIVES
scontinuation of the IUCD* (Lippes etermine the termination rates for
life table technique.
s and 507 pill acceptors, 169 and 259 and the Oral Pill at the time of
Respondents
IUCD
Oral Pill
552
507
169
259
30.6
51.1
given in Table 3.2.
on Rate of IUCD and
eptives
mination Rate
Number of Drop Outs. IUCD/Oral Pill users IUCD
Oral Pili
Oral Pill
9.0
26
45
78
24.9 39.4
45.8
47.1
56.7
57.1
57.7
57.7
72.4
72.4
t the country was the Lippes loop. O and Copper 380A were introduced

Page 32
|
Figure IL CUMULATIVE TER
Rate
watchinha
601
50.
401
30 -
20- |
=
:: 35 ਨੂੰ ਏ ਨੂੰ '
" 3 i.

IMINATION RATE
- Oral
- Loop
24
Months
A Filaren, einen

Page 33
The net cumulative discontinuation was considerably higher a than IUCD. At the end of 3 months the IUC rate of 11.1 per 100 acceptors while or as high as 24.9 per 100 acceptors. At th rates were 26.7 for IUCD and 47.1 for or rates stabilized for both methods from rates of 38.3 and 57.7 respectively for 24. months. However a sudden increase i methods was observed thereafter with ra IUCD ana Oral contraceptives respectively
Discontinuation was hig both methods and thereafter showed a lo tendency to discontinuation at the init from the 15th to the 24th month and ir to suggest a pattern of use. The initi tinuation was high could be considered acceptor really tries out the method. On a 'satisfied user' as seen by stabilizat The period from the 24th month to 27th time of decision-making when the user et method for a further period or discont: as to have another child or to change ove
Termination of IUCD
Termination rates accor are illustrated in Table 3.3.

termination rates indicate that mong users of oral contraceptives D had a net cumulative termination al contraceptives recorded a rate e end of 12 months the termination al contraceptives. The termination the 15th to the 24th month, with
· IUCD and Oral contraceptives at n the termination rates for both ces of 52.3 and 72.4 recorded for
h in the first three months for wer rate of discontinuation. This ial period with rates stabilizing icreasing sharply thereafter seems al period during which the disconas a 'period of trial' where the ice satisfied, the acceptor becomes tion in the discontinuation rates.
month could be considered as the ither decides to continue with the inues for a specific purpose such
r to a permanent method.
-ding to type of discontinuation

Page 34
Figure III CUMULATIVE TERMINAT
Rate
...
40
ਚ .. ਕ: 30 ਨੂੰ
ਵੀ 13 30 .
ਦਾ ਮ
ਤੇ 2 3 ..
ਹੈ , , , । ਚ 5. :
2011,
10
12

A
FION RATE BY TYPE OF EVENT-LOOP
A- Accidental Pregnancy T- Transmigration 0- Other
Total Termination Rate
Removal --Expulsion
--A+T+0
24 Months

Page 35
TABLE 3.
Cumulative Termination of
According to the Type o
Ta of
Net Cumula
Type of Discontinuation
Number Discontinnued
Month
| Months
Removals
1.8
3.8
Expulsions
2.5
6.4
n = 0
Accidental
Pregnancies
0.2
Others
0.4
0.7
4.7
| 11.1
Cumulative
Terminations
Expulsions have recorde mination rates upto 12 months of inser the highest termination rates. Terminatio nancy was found to be considerably low to termination due to expulsions and rates due to accidental pregnancy have : 12th month of use, increasing from 0.9 months.
These observations sugg bility of termination due to expulsion termination due to removal. This raises of insertion by programme personnel nee 1 year the pattern is reversed and the pi than the probability due to expulsion.
Reasons for removal of the IUCD
The main reasons for r
Table 3.4.

i NS
IUCD per 100 women
f Discontinuation
tive Termination Rate
6
9 12 18 Months
| Months
Months
Months
24 Months
9.8
11.5
17.4
17.9
5.9 10.2
| 12.7
13.3
16.2 16.2
else
3.1 3.1
0.9
0.9
0.6 0.8
1.0
1.0
1.1
17.5
24.4
26.7
37.7
38.3
d the highest net cumulative ter
•tion. Thereafter removals have ons as a result of accidental pregfor all time periods when compared removals. However, the termination shown a significant rise after the at 12 months to 3.1 at 18 and 24
est that upto 1 year, the probais higher than the probability of
the issue as to whether technique ed to be improved. However after Probability due to removal is higher
SEE EI TEE 6
emoval of IUCD are illustrated in

Page 36
Percentage Distr
due to Re
Main Reasons for Removal
Excessive menstrual bleeding Irregular bleeding
Abdominal cramps
Back ache White Discharge
Urinary problems
Generalize weakness
Other medical/physical reasons General -
Fear of ill health
Husband opposed Husband separated/divorced Got sterilized
Wanting to have another child May not conceive hereafter Other reasons
TOTAL
The main reason excessive menstrual bleeding, irr cramps which accounted for 46.2% stated that they changed over t that removal was requested because
24

BLE 3.4.
bution of Discontinuers
Oval of the IUCD
Discontinuers
Number
Percent
16.7 la
14.1
15.4
2.5
2.5
w w N ON NN | N =
2.5
10.3
2.5
3.9
3.9
14.1
6.4
1.3
3
3.9
78
100.0
s given for removal of the IUCD were egular bleeding, and frequent abdominal of all stated reasons for removal. 14.1%
sterilization and another 6.4% stated another child was desired.
E tamer

Page 37
TABLE 3.
Main Reasons for Removal
to Duration (
Main Reasons
0-3
4-6
7-9
Excessive bleeding Irregular bleeding Abdominal cramps
O o P o u
Resorted to
sterilization
o o un n -
– O –
Wanting to have another child
Of the 46.2% (36) who stated that the 1 irregularities and abdominal cramps, ap they requested removal of the IUCD during
TABLE 3.6 Sterilization among IUC
According to Time of
and Number of Livi
Number of Living Children
12 months
Number Sterili
15-18 months
1-2
ol o o o
- o
4 and over
Total
Percentage
36.3

5
| of IUCD according
pf Use
onths
10-12 13-18
19-24
>24
Total
1 | 1 | 13
- N N
O -
| 0 | 11
0 12
– O – O –
O NO
o uno o -
u = R = w
1 3
IUCD was removed due to menstrual proximately 58% (21) stated that
the first six months.
CD Discontinuers
= Termination ng Children.
ized
I 19-24 | months
19-24 Months
Total
> 24 months
O - -
o un
11
18.2
45.5
100.0

Page 38
It is no over to sterilization had used the and 81.8% had 3 living children.
The above to be an understanding among moth temporary methods, spacing in the and postponement among others with to accept a permanent method.
Discontinuation of Oral Pill
Percentage Distri.
of Oral
Reasons for Discontinuation
Medical Reasons:
Nausea and vomiting Feeling dizzy Frequent Headaches Menstrual Disturbances
Other medical reasons
General Reasons: Inconvenient to take daily Harmful to health Difficult to obtain pills Separated from husband Changed over to sterilization Wanted a child Accidental pregnancy Other reasons
Total
26

te worthy that those who have changed IUCD for a minimum period of 15 months
observations suggest that there appears ers about the rationale for the use of case of those who wanted more children 2 or 3 children till a decision is taken
BLE 3.7.
bution of Discontinuers
Contraceptives
Percent
Total number Discontinuing
19.7
19.0
• 1,6
11.6
10.8
* * * = 0 + 0 0 & N
8.1 2.3
1.5
3.1
3.1
7.7
4,6
18
6.9
259
100.0

Page 39
The main reasons fo ceptives were nausea/ vomiting, dizziness comprised 50,4% of all reasons. "Inconve "wanting to have another child" listed discontinuation. Accidental pregnancies uers. Cnly 1.6% of discontinuers stated due to difficulties in obtaining supplies
TABLE 3.8
Percentage Distribution of Oral Pill according
Time of Term
Main Reasons
Durat
| 4-6
A-6 7-9
0-3
· Nausea/Vomiting
68.7
11.7
11.7
55.1
10.2
Feeling dizzy Frequent
Headaches
100.0
Menstrual
Disturbances 1 43.4 Changed to
sterilization
.
· · 3
Discontinuation of feeling dizzy, frequent headaches and during the first three months. Thereaft a steady decline. Discontinuation as a zation was observed only after about 14 y
These observations follow-up, reassurance and advice by he the first six months following commencemer

or discontinuation of oral contra
and menstrual disturbances which nient to take the pill daily" and
high in the general reasons for accounted for 4.6% of discontina that they had to stop the pill
of Discontinuers i to Reasons and tination
- 3 2 i
3
Aria
ion in Months D-12 | 13-18 | 19-24
25+
Total % Number
7.9
51 100
49 100
IF
4 100
n = * 8.
6.6
13.3
30 100
75.0
25.0 | 8 100
orals due to nausea/ vomiting, nenstrual disturbances was highest er these side effects have shown result of change over to steriliears of use.
highlight the need for regular alth workers, particularly during nt of the oral pill.
| 27

Page 40
Distribution of Di:
Contraceptives acci
Education
TOTAL
SAMPLE
22
177.
No schooling Grades 1 - 5 Grades 6 - 9 GCE O'Level
246 94
GCE A' Level
and Above
TOTAL
552
Discontinue than for IUCD at all educationa continuers of oral contraceptiv whereas for IUCD the proportio with primary or secondary levels ively for the two groups). It is of oral contraceptives decreased as for IUCD, terminations were le and those with higher levels of
as die

scontinuers of IUCD and Oral
ording to levels of Education
IUCD :
ORAL CONTRACEPTIVES
DISCONTINUERS
TOTAL
DISCONTINUERS
HUMBER
PERCENT
SAMPLE
NUMBER
PERCENT
27.3
29
58.6
公子
135
54.8
33.3 32.9 21.3
105
á a
213 114
49.3 48.2
55
23.1
16
50.0
169
30.6
507
259
51.1
rs were higher for oral contraceptives | levels. The highest proportion of dise (58.6%) were women with no schooling n discontinuing was highest among those ; of education. (33.3% and 32.9% respect
of interest to note that discontinuation with increasing levels of education where!ss among those with no schooling (27.3%) education - GCE O' level and above (23.1%).
era inte

Page 41
CHAPTER SELECTION, MOTIVATION AND COUN
CONTRACEP. The main reasons for choosing the far aspects of the services provided to ac ceptives are discussed in this section.
Reasons for Accepting the Contraceptive M The main reasons for choosing the IUCD an ted in Table 4.1.
* TABLE 4.
TABLE 4. Distribution of Acceptor
to Reasons for Selec
Main Reasons
Number
Easy to use
- 67
Easily obtainable Reliable Method
254
Harmless
Because the method is used
by friends/relatives Husband prefers this method
Easy to discontinue Other reasons
6- - :
Total
560
Although only 552 and 507 acceptors of I there were 560 and 523 responses since a few acceptors had stated more particular method.
45.3% and 41.7% of acceptor responses for tives were because they considered the of responses among IUCD users and 32.12 the particular method because it was easy and 10.1% of IUCD & Oral Pill users stat cause they thought that the particular me

4 SELLING FOR IUCD AND ORAL TIVE TIVE
nily planning method and certain ceptors of IUCD and oral contra
ethods 1 Oral contraceptive are illustra
1.
Responses according tion of Method
Accoptor Responses
UCD
Oral Contraceptive Nu ber 97
18.5
18,4
12.0
71--
13.6 41.7
45.3
218
10.9
53
10.1
3.4
2.3
ܝܸܝ̄ ܚ ܇ 8
0.2
0.4
10
1.9
9.8
i 60 gente
11.5
100.0
523
100.0
ICD and Oral Pills were interviewed
respectively for the two methods than one reason for selecting the
choosing IUCD and Oral Contracepmethod to be reliable. Another 30.4% % of oral pill users had selected - to use or easily obtainable. 10.9% ced that they chose the method bethod was harmless.
29

Page 42
These responses suggest that the in their selection taking into i bility, ease of use and safety b small proportion had selected tt either by friends or relatives or gests a high degree of selectivi a family planning method.
Source of Motivation -Data regarding the source respons tice of the method was collected a
Origin o T
Distribution accord
AN SE
SOURCE
Medical Personnel
(MO/MOH, AMP/RMP) Public Health Midwife (PHM)
of Area Other Field Health Workers Institutional Health Workers F.P. Workers of Non-Governmental
Organizations Health Volunteers Relatives/Friends Husband til at iba Others and signes
Total 992 TO SE
Of the acceptors of IUCD and Oral ively stated that they were motiva Relatives or Friends appeared to for IUCD acceptance.
Slado "O SEU 3 ਡਿਨ ਨੂੰ $ 3 ਤੇ 3 ਤੋਂ 4
esine 5 bod
30

majority of acceptors had been objective account factors like reliability, availaefore deciding on the method. Only a very e particular method because it was used - because of spouse preference. This sugty among respondents regarding choice of
ible for the respondents acceptance/pracnd analysed.
* CABLE 4.2.
ing to Motivation Personnel
Ácceptors
IUCD Number $
Oral contraceptive Number
0.5
10
2.0
468
84.8
456
89.8
ਚ 31 ਨੂੰ
1.4
| 8
1.6 1.4 | 8
NETE 0.9
7 se 1.4
1.1
1.6
W o un o w
2.0
6.0
10
| 951.63
12
2.3
0.6 1.0
5
|
552 100.0
507
100.0
contraceptives, 84.8% and 89.8% respectted by the local PHM to accept the method. play some part in the motivation process
Z En fit sed en langes
seu EE Ft Tu To Na MS ist alustas ta on iguan se sa
| *

Page 43
The data indicates that the local PHM actually comes to accepting and practisi Previous studies have shown that the other health workers also play an imp by dissemination of information about
The PHM is responsible for the domicil within her area. The provision of fè are part of her functions during routin study highlights the importance of inter in the home situation for improving accep planning methods.
One would expect the PHM rating to be sample was mainly selected from Governme past studies have shown that 97.9% of IU services are provided through government
Family Planning Advice and Guidance befor Data in respect of advice and guidance a family planning method is illustrated i
TABLE 4. Distribution of Respo
to person provi
Persons providing advice
and guidance
Medical Officer/MOH/RMP/AMP Health Workers at clinic/
institution
Area Public Health Midwife
Others
No Response
Total
1. Family Health Impact Survey - 1981/82

has had a major influence when it ng a modern family. planning method. mass media, friends, relations and -ortant role in creating awareness t family planning."
iary care of mothers and children amily planning advice and services e home visits. The findings of this personnal communication particularly ptance and practice of modern family
CSOT
very high in this study since the nt clinics and PHM records. However, ICD and 62.5% of oral contraceptive
service outlets. -e or after accepting method e either before or after accepting in Table 4.3.
-3.
ndents according
ding advice
IUCD Number
Respondents
Oral contraceptive Number
14
2,5
55
10.0
4.3
456
82.6
94.1
2.5
1.6
14 13
3. &
2.4
552 100.0
100.0

Page 44
The local PHM has been listed, very er before or after the method was. ceptives. 82.6% of IUCD users an the local PHM had given them the before or after accepting the me in respect of the IUCD is probab by the PHM during home visits, af the IUCD clinic at which she is a 10.0% stated that either pre-inser ed at the clinic/institution. I direct clinic contact although i been given and re-inforced in the
This observation highlights the routine procedure by health staff Institutions where family planning
32

nigh in providing advice and guidance eithdopted, for both IUCD and Oral Contra94.1% of oral contraceptors stated that
necessary advice and instruction either thod. The high level of PHM influence ly due to the advice and guidance given ter which the PHM links the acceptor to Iso present. In the case of IUCD, only tion or post insertion advice was providhis probably relates to those who made deally advice at home should also have :linic situation.
importance of counselling as a part of
in Family Planning Clinics and Medical services are provided.

Page 45
ES
CHAPTER
en la jaroSUMMARY . & CC
Temporary Modern Contraceptive National Family Planning Programme sine on Family Planning Acceptors through t little information is available on the This study has sought to provide data on uterine Contraceptive Device (Lippes Le and to probe deeper into certain aspects I
Data was collected in respect of tors. At the time of the survey 383 resp and 248 were continuing to use the pill.
The study revealed that the IUCD higher continuation than the oral contı
Continuation & Reten
Oral Contraceptive
Type of
Method
12
Ordinal month after | 369 | 12 | 91.0 |75.1 || 60.6 54.2 52.9) 95.3 88.9 | 82.5 | 75.6 | 73.3 |
Oral Pili
IUCD
Both methods showed a high first three months. At the end of the t rates of 75.1 and 88.9 percent were obs. respectively and thereafter continuation/ percent respectively were recorded for th of 1 year. The continuation rate at the 42.3 percent and the retention rate for I cent.
The expectation of use calcula for Oral Contraceptives it was only 1.8 IUCD affords greater couple years of prot

- 5
NCLUSION
e Methods have been used in the ce 1968. Though data is available he routine reporting system very
duration of contraceptive use. the duration of use of the Intra pop) and the Oral Contraceptive, regarding their use.
552 IUCD and •507 oral pill accepondents were still using the IUCD
once accepted had a significantly raceptive for all time periods.
tion Rates of
es and IUCD
· Commencement
15 | 18 | 21 24 | 27 | 30
43.3
42.9
42.3
| 42.3
27.6
27.6
62.3
62.3
61.7
61.7
47.7
47.7
ontinuation/retention during the hird month continuation/ retention erved for the Oral Pill and IUCD retention rates of 52.9 and 73.3 e Oral Pill and IUCD at the end end of 2 years for Oral Pills was UCD remained as high as 61.7 per
ced for IUCD was 3.5 years while
years. This indicates that the ction than the Oral Contraceptive.
33

Page 46
As mentioned earlier, pro higher among Oral Contraceptors tr initial period showed a high propa Thereafter rates stabilized from t sharp rise in the proportion of d be considered as a 'period of tri out the method. This is followed a 'time of decision making' whereir with the method or terminates the m ge over to a permanent method or to
Expulsions recorded the for IUCD during the first twelve shown the highest net cumulative accidental pregnancy was low for trend was observed with time.
The main reasons for remo bleeding, irregular bleeding and 46.2% of total removals. Switch-o approximately 14% of total removals
The main reasons for disi nausea/ vomiting; dizziness; and men due to these side effects were h Thereafter it showed a steady dec after use for a minimum period o 3% of total discontinuers. ora
86.6% IUCD acceptors and i the method based on reliability, bility which indicates that the mi selection of a contraceptive method
Data from the study rev motivating factor for actual acce methods, though past studies have : and health workers in medical ins in creating awareness through the planning. The local PHM has been and guidance both before and after
34

portion of discontinuers was considerably an IUCD users for all time periods. The rtion of discontinuers for both methods. he 15th to the 24th month followed by a iscontinuers. The initial period could Il' during which time the acceptor tries by a 'period of satisfaction' and then 1 the acceptor either decides to continue ethod for a specific purpose.(Eg. to chan
have another child).
highest net cumulative termination rates
months. After 12 months, removals have termination rates. Terminations due to all time periods although an increasing
val of the IUCD were excessive menstrual
abdominal cramps, which accounted for ver to a permanent method accounted for
continuation of Oral Contraceptives were strual disturbances (50.4%). Terminations ighest during the first three months. line. Switch-over to a permanent method f 18 months accounted for approximately
33.9% of Oral Contraceptors had selected safety, ease of use and service availaajority had been objective regarding the
of their choice.
ealed that the local PHM was the main =ptance and practice of family planning shown that mass media, friends, relations stitutions had played an important role
dissemination of information on family listed 'very high' for providing advice acceptance of a method.

Page 47
This highlights the importance of interpe planning particularly in the home situati vide in the coverage of her routine duties.
In the clinic situation however p of IUCD acceptors appeared to be low. Mo at Government Family Planning Clinics/Cent ceived the necessary advice and guidance situations the local PHM also assist at 1 for the low level of pre and post inser situation. This is a weakness that needs c should strengthen and re-inforce the advi field.
DE SANTA MARIA
|

rsonnel communication for family on which the PHM is able to pro
re and post insertion counselling st acceptors who sought services cres may be presumed to have re
through the local PHM. In most Ehese clinics. This may account tion counselling in the clinic Drrection since ideally the clinic ce and guidance provided in the
A
KANADA
WAKA MWANAKEMIA KUTOA TAAS KOM
• TEKENAAN DENGAN MAYOR A NAME ANE TAMEN MAL PRAEL FERNANTE WAT AAN DAERAH TINGKAT ANTARA TAMEN LA BASE NA

Page 48
167 159 144 138 134 122 114 95
.0084388185
'22:2 163.0 151,5 141.0 136.0 128.0 118.5 104.5
92.0 85.5 79.5 71.5
89
ER 888 - 986 9 RR8 G8
o o o o oio o o o 9° oo o o o i
i I III
1.0000000 1.0000000 1.0000000 1.0000000 1.0000000
.991561182 1.0000000 1.0000000 1.0000000 1.0000000 1.0000000 '.772357724 1.0000000 1.0000000 1.0000000 1.0000000 1.0000000
.888888889 1.0000000
.623178896 .623178896 .623178896 .623178896 .623178896 .623178896 .617920002 .617920002 .617920002 .617920002 .617920002 .617920002 .477255281 .477255286 .477255286 .477255286 .477255286 .471255286 .424226921
66
61.5
.227642276
45
26
37
33
40.0 35.0 31.0 28.0 21.5
9.0 0.5
III LI
29
.111111111
14 01
383
169
Nx = Women admitted to the programme between 1st
January 1982 and January 1st 1983, and followed to July 31st 1984 or to their point of termination with the programme.
N'x = NX-Cx)= Correction factor (1)Assumption:- is used assuming with
drawals occur evently through period X,X+1.
(2) Assumption :-P. = 1
Px+1 = PX

APPENDIX I
TABLE 1 RETENTION RATES OF LOOP - 1984/85
NX
CX
Dx
TIME AFTER INSERTION (IN MONTHS)
NO USING AT EXACT TIME
NO STILL USING AT THE CUT OFF DATE AT DURATION
TOTAL DISCONTINUING BETWEEN X AND x + 1 (WHO SAID HAD USED FOR X MONTHS)
N'x ADJUSTED NUMBER EXPOSED TO RISK OF TERMINATING (Nx - 4 Cx)
26
24
10
552 523 496 451 405 382 352 318 266 244 225
S-a o ovo w N -
qx PROBABILITY OF STOPPING FOR ANY REASON BETWEEN X AND x + 1 IF STILL USING AT X (Dx/N'x) .047229791 .046021093 .020898641 .043428571 .017632241 .013531799 .02359882 .023688663 .038461538 .021097046 .00909090
05
S. Ba as & & 9 ENN
550.5 521.5 478.5 437.5 397.0 369.5 339.0 295.5 260.0 237.0 220.0 207.5 1905
px
PX PROBABILITY OF
PROPORTION STILL CONTINUING USE
USING AT EXACT THROUGH INTERVAL
| TIME X. (The FROM X, (x+1) IF.
cumulative contiSTILL
nuation and (1-qx).
Retention Rate) .952770209
1.00000 .953978907
.952770209 .979101359
.908922682 .956571429
.889927433 .982367759
.851279157 .986468201
.836269197 .97640118
.824952971 .976311337
.805485054 .961538462
.786404 19 .978902954
.756157875 .9909091
.740205178 1.0000000
.733476046 840624061
733476046
05
02
213
202
150375939

Page 49
CONTINUATION RATES OF ORAL PILL - 1984/85
qx
PX
TIME AFTER
START
(IN MONTHS)
Nx
NO USING AT
EXACT TIME
NO STILL USING AT THE CUT OFF DATE AT DURATION
DX
N'x
TOTAL DISCONTINUING
ADJUSTED NUMBER
BETWEEN X AND x + 1
EXPOSED TO RISK (WHO SAID HAD USED OF TERMINATING FOR X MONTHS)
(NX - 4 Cx).
I
45
42
12
507
460
406
348
295
| Q N = 0 0 0 J o un A w N - O
PROBABILITY OF STOPPING FOR ANY REASON BETWEEN X AND x + 1, IF STILL USING AT X
(Dx|N'x)
| .088932806
.092511013
.09113924
.108823529
.045296167
.050682261
.048565121
.034739454
.026954177
.011428571
.0059880239
.00625
.183006536
266
8 & & WG 666N
px
PROBABILITY OF CONTINUING USE THROUGH INTERVAL FROM X, (x + 1)
IF STILL
(1-qx)
.911067194
.907488987
.90886076
.891176471
.954703833
.949317739
.951434879
.965260546
.973045823
.988571429
.994011977
.99375
.816993464
1.0000
1.0000
PROPORTION STILL USING AT EXACT TIME X. (The cumulative contis nuation and retention rate)
1.00000
.911067194
.826783445
.75143103
.669657653
.639324728
.606922306
.57744705
.557386797
.542362895
.53616445
* .532953897
.529622935
.432698476
.432698476
506,0
454.0
395.0
340.0
287.0
256.5
226.5
201.5
185.5
175.0
167.0
160.0
153.0
118.0
111.5
234
208
188
178
170
163
07
o o - - N un
156
OO
122
114

.0094786729
.012048192
o o o o o o o o o - o o -
8 29 8 988
105.0
96.5
89.0
83.0
75.5
67.5
62.0
58,5
52.0
46.0
27.0
25.5
23.5
18.5
13.5
.990521328
1.0000
1.0000
.987951808
1.0000
1.0000
1.0000
1.0000
1.0000
.652173913
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
.432698476
.428597069
.428597069
.428597069
.423433249
.423A33249
.423433249
.423433249
.423433249
.423433249
.276152119
.276152119
.276152119
(276152119
.276152119
.276152119
.276152119
.347826087
25
22
0
9.0
06
- 0
3.0
248
259
Nx = Women admitted to the programme between 1st
January 1982 and January 1st 1983, and followed to July 31st 1984 or to their point of termination with the programme.
N'x = (NX-ICx)= Correction factor (1)Assumption :-4 is used assuming with
drawals occur evently through period X,X+1.
(2) Assumption :- P. = 1
P3+1 = PX

Page 50
ANG MGA
una May WERD YN SAN STEDE EN
TABLE III MONTHLY AND CUMULATIVE TERMINATION RATES BY TYPE OF EVENT - LOOP - 1984/85
Time Total
No Discontinuing
After
disco-Between x and x+1 by Inser--ntin
Type of Termination
tion
| UOus
Probability of stopping Between x and x+1 it still
using at x by type of termination
Continuation
Retention
Rate
Monthly Termination Rates Between x and x+1 by Type of Termination
Adjusted
Number Ext
posed to
Risk of
Termina
ting
N'x
Cumulative Termination Rates
by Each Type
Total
Cumul
ative
Termi
nation
Rates
| Ax
Tx|
Ox
Rqx
Eqx
Aqx
Tqx
Οqx
Px
Dx=RX+
| Rx
Ex+Ax+
Tx+0x
| 26
0-1
1-2
.00182
.00182
.00182
.00182
24
.00192
.047
2-3
3-4
.00209
.0019
.091
.00229
.00204
.00229
.00252
4-5
39 & 1965
550.5
521.5
478.5
437.5
397
369.5
339
o o N = N * * OM N O
O ON AN w wn w y G
oooo -oo--o-o
- o -o oooooooo
- o o - o o - o ooo o
5-6
6-7
7-8
8-9
9-10
10-11
|11-12
|.01817
.02543
.01726
.02685
1.004 18.01463
1.00914
.02971
.01008
.00503
1.00541
.00812
.0118
.00885
.01354
.00677
.02308
.01538
.01266
.00844
1.00909
1.00000
.95277
.90892
.88993
.85728
.83627
.82495
.80549
.78640
.75616
.74021
13348
.01817
.01644
.00380
.00813
1.00858
1.00452
.00973
.01091
.01815
.00957
00673
.02543
.02557
.00183
.01330
.02643
1.00204
.00428
.00216
.00679
.00730
.00545
.00272
1.01209
.00638
.01817.02543
.03461 .05101
.00183
,03841 .06431
|.00183
.04654 .09074
.00387
.05512 | .09502
.00603
.05964 .10181
1.00603
.06937 .10911
1.00638
.08028 .11456
1.00875
.09843 | .12268
1.00875
.10804 .13303
.00875
.00182
.00182
.00372
.00372
.00372
.00372
.00372
.00372
.00372
.00372
1.00182
.00182
.00182
1.00386
.00386
.00386
.00629
.00629
.00629
|.00629
.110
.143
.164
.175
00295
.00243
295.5
.00338
. 195
.214
| 05
| || ||
.244
260.
237
220
207,5
02
.260
11179
1770,
aanse

|12-13
13-14
.08020[.0401
.03008
.00883
.02941
02206,ܐ
.267
00875,ܐ
03081.ܐ 16244.
.377
.377
.14-15
|15-16
.03081
.03081
17-16ܐ
7-18ܙܐ
.377
.377
ܗ̄ ܘ ܘ ܘܙܘ ܘ ܝ ܘ ܘ ܘ
199.5
163
151:5
141
136
128
118:5
104.5
o3081.ܐ
ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܂ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܯ
.03081
.377
ܐ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܣ ܢ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܘ ܩ
ܙ ܙ ܀ 11 ܙ ' ܙ ܙܙ
ܙ ܙ ܙ ܐ
:01
.00843
18-39
19-26
20-21
21-22
[22-23
23:24
ܙ ܙ ܙ ܙ ܙܙ ܙ ܙ ܙ ܙ ܙ ܙܙ
ܙ ܙ ܙ ܙ ܙ ' ' ' ' ܙ ܙ ܙ ܙ
.73348
.623:8
.62:18
.62:18
.62:18
.62318
.62:18
.61792
.61792
.61792
.61792
.6i792
.61792
.00526
܀ 11 ܙ ܙ ܙ.
ܙ ܢ ܙ ܙ ܙ ܙ ܙ ܙ ܙ ܙ ܙ ܙܙ
ܙ ܙ ܙ ' ܙ ܙ ' ܙ ܙ ܙ ܙ
.11477
.133O3
.1736
.1736
.16244
.1736
.16244
.1736
.16244
.1736
.16244
.1736
.16244
.17885
.16244
.17885
.16244
.17885
.16244
.17885
.16244
.17885
.16244
.17885
;16244 .28937 ,18253
03081.ܐ
،377
.00372
.oo372
.00372
.00372
.00372
.00372
:00372
.oo372
.00:72
.00372
.00372
.00372
.00372
.00372
(,00629
.00629
.OO629
.00629
.00629
.0629
.00629
.00629
.00629
.00629
.00629
.00629
.00629
.00629
[.03081
92
03081.ܐ
ܘ ܘ ܘ ܘ ܘ
ܘ ܘ ܝ
85,5
79:5
715
615
.03081
.03081
.382
.382
.382
.382
..382
.382
03081.ܐ
24-25
.17886
.03252
.01626
.11052
01005.ܐ 02009.
.03081
4086,ܐ
R- Removal
- ܐܶ.
Monthly termination rate due to Removal
Based on assumption that there are no dropouts during 1st month (Time after insertion = 0
E - Expulsion
E -
Monthly termination rate due to Expulsion
܀ (se montheܢ duration of ܂ ܘ 5+1
A - Accidental Pregnancy
A
Monthly termination rate due to Accidental Pregnancy A
rk 5]55 #
:
1 - Transmigation
ܠܐ ܕܠܐ ܀
ܕܪ ܝܬܐ ܪܬܐ ܕܠܐ: [1] 16 = . ܕ ܕ ܐ other - ܘ_2NF_FIE ܐ܂
ܐܠܐ ܠܐ Monthiy termination rate due to Transmigation
- ܘ
Monthly termination rate due to other Reasons.

Page 51
TABLE IV MONTHLY AND CUMULATIVE TERMINATION RATES BY TYPE OF EVENT - ORAL PILL 1984/85
Time
After
Start
Total
Discon
tinu
tion
CETTE
No. discontinuing x and x+1
by type of termination
Adjusted
No. Ex
posed to
Risk of Termina
ting
Continuation
Retention
Rate
Probability of stopping between x and x+1 if still using at x by type of termination
DX =
Ax+BX+CX
Ex+FXitx}
+Ix+dx
Bx
Ex
Fx
N'x
AqХ
Bqx
Cqx
Eqx
Fqx
Hqx
Iqx
Jqx
PX
0-1
45
506
.02174
.02767
.00198
.00593
.00395
.01186
.01581
1.00000
1-2
454
.02643
.02203
.0022
.0022
.00441
.00661
.02863
2-3
395
.03038
.00759
.00759
.00253
..00759
.02532
.01013
.01765
.91107
.82678
.75143
3-4
340
.01176
.02647
.00294
.00294
.03529
.01176
.00348
4-5
"м и 2 м о и в в
. . . . . .
.00348
.00697
.02091
.66966
.00697
.01559
5-6
'' - N w -- A N N
.03119
1 N . ! - I - - w NN
! !! !! ! ! ! -
.63932
! ! ! - - - - - - W
| 11. || ! - - !
! ! - ! ! ! No » w o
- N w wo o N 3 W
287
.00348
256.5 |
.0039
226.5 |
.01325
201.5
.00993
6-7
.01325
.00442
.00442
7-8
.00993
· 8 · .
.01325
.01489
.01078
.60692
.57745
.55739
8-9
185.5
.00539
.00539
.00539
9-10
175
.01143
.54236
10-11
167
.00599
.53616
11-12
160
.00625
.53629

153
.02614
.00654
.01961
.01307
.11765
.52962
.43270
12-13
13-14
14-15
15-16
118
111.5
105.5
.43270
.00948
.43270
96.5
! !! !w
.42860
16-17
17-18
18-19
19-20
8 o 0 - 0 0 - 0 0 0 0 0 0
68
TILALL
.42860
· · · · · · · · · · · · -
NII I II ! !
. . . . . .
O - I-II || - | --. II--o
83
2 a a & 8 9 3 . . . . . . . . . . .
*.01205
.42860
! !! !! !! !
75.5
.42343.
8 , . , . . .
| 1
20-21
67.5
.42343.
21-22
62
.42343
al
22-23
58.5
.42343
23-24
52
.42343
24-25
10
46
.02174
.02174
.08696
.21739
.42343
Feeling Sick and vomitish Feeling. Dizzy
NAS SE YON VIETNAMUS NEGARA Always having a Headache Irregular.Mensus
F -
No Mensus
H -
Heavy Mensus I - Other Reasons
General Reasons
USE
A i dag
U. W
---

Page 52
Table IV Continuation
Per Anton Monthly Termination Rates Between x and x+1 by type of Termination
Total
cumulative Termination Rates
Cumulative Termination Rates by Each Type
CAN
H
.02174
.02767
.00198
.00593
.01186
.01581
.0020043
.0260839
.02767
.00593
.02174
.0458195
.00198
.00198
.00395
| .0079678
.0062752
.00395
1.0040178
.0062752
1.0022092
.0023304
.0946
.1732227
.0209341
.0477408
.0079343
.0020043
.0200708
.0062752
.0198903
.0046675
.0020043
.0020917
.0088368
.0023304
.01581
.04 18939
.062828
.0240795
.0251176
.0088368
.0023304
.0024933
.0080417
| .0060221
.0083753
.0132627
.0046675
.0022092
.010026
.01423
.0265180
.0140025
.054016
.0739063
.008255
.008255
.2485526
.33033
.0188628
.0020043
.0042135
.0042135
.0042135
.0709371
.0797739
.0821043
.0845976
.0926393
.0199405
.01186.
.0178821
.0262574
.0395201
.044 1876
.0441876
.0441876
.044 1876
.0785738
.008255
.0211932
.0099670
.0080417
.3606585
.089346
. 1033485
.123289
.1313307
.0026825
.0026825
.0885408
.008255
.0164522
.0187826
.0187826
.0214651
.0214651
.0214651
.0080417
.0085981
.0060086
.005734
.005734
.3930593
MAN
.4225494
.0211932
.0238757
.0238757
.0965825
.008255
.0042135
.0030043
.0030043
.0030043
.0983733
.1023165
.008255
.0042135
.1399288
.4426155
...
. . . . . .
.0061992
.1013776
1.1023165
.008255
.02688
.0042135
.0471919
.1459374
.457637
.1013776
.1023165
.008255
.02688
.0276643
.0032115
.0033309
.0623101
.101.3776
.008255
.02688
.1023165
|.1023165
.0042135
.0042135
.0042135
.0276643
| .0276643
.0471919
.0471919
.0471919
. 1459374
. 149149
.1524799
.4638362
.4670478
.4703787
.01 38443
.0034637
.0103859
| .0069221
.1013776
.008225
.02688

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F
---+-","-" >
Monthly termination rates due to sickness and vomiting. Monthly termination rates due to feeling dizzy. Monthly termination rates due to headache. Monthly termination rates due to regular menses. Monthly termination rates due to no menses. Monthly termination rates due to heavy menses. Monthly termination rates due to general reasons.
Based on assumption that there are no dropouts during ist month (Time after insertion = o duration of use month)
TEREN
LI TILI
F
AT THE LEAVE IT

Page 53
SURVEY TEAM
Dr. N.W. Vidyasagara
Project
Dr. K.P. Wickrama suriya
Project
Mrs. S.S. Niunehella
Statist
Mrs. K. Gamalath
Public
Mr. S. Gamage
Program
Mrs. K. Wijesuriya
Data Co
Mrs. A.R.D. Chandralatha
Data En
| | | | | | | | | |
Data En
Mrs. W.M. Malani
Miss I. Marasinghe
Data En
Mr. S.B. Karunaratne
Data En
Mr. P.G. Gunesinghe
Statist
Mr. S. Jayakody
Statist
Mr. K. Piyadasa
Statist
Mr. B.H. Perera
Statist
Statist
Mrs. W.W.C. M. Mendis
Miss A.R.T. Wijebandara
Typist
INTERVIEWERS
Public
Ms. K.P. Perera
Ms. H.C. Somawathie
Public
I LES
Ms. D.C. Hemawathie
Public
Ms. D.P. Malini Samarakone
Public
Ms. E.A. Malani Edirisinghe
Public
Ms. M.R.L. Padmaseeli
Public

APPENDIX II
Director
Manager
ician
Health Nursing Sister
mer
ntroller
try Operator
try Operator
try Operator
try Operator
ical Officer
ical Officer
ical Survey Officer ical Survey Officer ical Investigator
Health Midwife - Team Leader
Health Midwife
Health Midwife
Health Midwife
Health Midwife
Health Midwife

Page 54
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Page 55


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