The contraceptive use behaviour before and after unintended birth in Colombia and Peru: does it change?

Ewa Batyra, London School of Economics and Political Science (LSE)

Despite high contraceptive prevalence rates, unintended childbearing is widespread in Latin America. In Colombia, the proportion of births reported as unintended increased since 1990s from 35 to 55%, in Peru it has been stable at a level of 55%. Contraceptive use has been widely studied as a determinant of unintended birth. Little is known about the contraceptive behaviour after unintended childbearing, with scant evidence from middle income countries. This research using DHS aims to examine whether the contraceptive use behaviour changes before and after unintended birth. This knowledge is important not only to understand high levels of unintended childbearing in Latin America, but also non-negligible levels of repeat unintended pregnancies. This study applies transition matrices and discrete-time competing-risk hazard models to examine whether, and how, the transition to first contraceptive method adopted in the postpartum period depends on the contraceptive use behaviour before pregnancy, and how this relationship differs by birth intention status. The results reveal that in both countries women who reported an unintended birth following contraceptive use (contraceptive failure or discontinuation due to reason other than to become pregnant) are more likely to transition to more effective methods after birth, compared to pre-pregnancy use, than women who reported a birth wanted then. This is most pronounced among former least effective method users. Moreover, although there is no statistically significant difference by birth intention status, non-users of contraception before pregnancy are most likely of all women to stay non-users also after birth. These findings signal that unintended birth experience might affect future contraceptive use behaviour, in particular among women previously using least effective contraceptives. At the same time, the non-use of contraception before pregnancy in general is a strong predictor of method non-use in the postpartum period, potentially putting women at risk of subsequent unintended pregnancy.