Volume 44 - Article 37 | Pages 879–898  

Has contraceptive use at pregnancy an effect on the odds of spontaneous termination and induced abortion? Evidence from Demographic and Health Surveys

By David A. Sánchez-Páez, José Antonio Ortega


Background: Contraceptive failure increases the chances of pregnancy termination, including both induced abortions and spontaneous terminations. Proper separation requires accounting for competing risks of pregnancy outcomes.

Objective: To measure the differential risk of spontaneous termination and induced abortion according to contraceptive use prior to pregnancy based on pooled Demographic and Health Survey calendar data.

Methods: We use multinomial logistic models controlling for demographic and socioeconomic variables to estimate the differential risk of spontaneous termination and induced abortion according to contraceptive use at the time of pregnancy. We address data limitations including recall error, omission error, and possible misclassification of outcomes.

Results: We find higher risk of induced abortion (RRR = 7.18, CI = 6.38–8.09) and spontaneous termination (RRR = 1.38, CI = 1.13–1.69) after contraceptive failure, with stronger effect for women under 30. Parity, union status, education, and wealth have a strong effect on induced abortion. Regarding spontaneous termination, age mainly explains the increased risk.

Conclusions: Since pregnancies following contraceptive failure are less likely to end in a live birth, aggregate models of the impact of family planning should reflect that contraceptive use and induced abortion conform interdependent strategies and that spontaneous termination is a competing risk of induced abortion.

Contribution: This is the first study reporting differences in the risk of spontaneous termination and induced abortion according to contraceptive use prior to pregnancy. We account for competing risks using a multinomial logit model of pregnancy outcomes conditional on pregnancy, new in the literature. Data limitations are addressed in novel ways.

Author's Affiliation

Other articles by the same author/authors in Demographic Research

Adolescent contraceptive use and its effects on fertility
Volume 38 - Article 45

Tempo-Adjusted Period Parity Progression Measures:: Assessing the Implications of Delayed Childbearing for Cohort Fertility in Sweden, the Netherlands and Spain
Volume 6 - Article 7

Tempo-Adjusted Period Parity Progression Measures, Fertility Postponement and Completed Cohort Fertility
Volume 6 - Article 6

Most recent similar articles in Demographic Research

Religion and contraceptive use in Kazakhstan: A study of mediating mechanisms
Volume 50 - Article 21    | Keywords: contraceptive use, Generations and Gender Programme (GGP), Kazakhstan, mediation, religion, religiosity

Does the fulfillment of contraceptive method preferences affect contraceptive continuation? Evidence from urban Kenya, Nigeria, and Senegal
Volume 50 - Article 5    | Keywords: contraceptive discontinuation, contraceptive dynamics, contraceptive preferences, contraceptive use, family planning, patient-centered approach, preferences

Measuring contraceptive use in India: Implications of recent fieldwork design and implementation of the National Family Health Survey
Volume 47 - Article 4    | Keywords: contraceptive use, measurement, population survey, survey design

Contraceptive use and fertility transitions: The distinctive experience of sub-Saharan Africa
Volume 46 - Article 4    | Keywords: contraceptive use, family planning, fertility, proximate determinants, sub-Saharan Africa

An investigation of Jordan’s fertility stall and resumed decline: The role of proximate determinants
Volume 45 - Article 19    | Keywords: contraceptive use, fertility, fertility stall, Jordan, marriage