Contraceptive Discontinuation and Switching in Brazil
Iuri da Costa Leite, Escola Nacional de Saúde Pública
Neeru Gupta, Institute for Development in Economics and Administration (IDEA International)
The Brazilian fertility rate is as low as that of many developed countries (2.5 in 1996), although important variations persist across social groups and regions. This paper examines the impact of contraceptive discontinuation and switching on Brazil's fertility transition, using data from the calendar module of the Demographic and Health Survey. Multilevel discrete-time competing risks hazard models are used to estimate the random- and fixed-effects on the probability of a woman making a specific transition at a given duration of use. Individual-level predictors include time-varying variables captured from the calendar. Municipal-level data are merged to assess the influence of the health service environment. Female sterilisation and the pill are the most commonly used contraceptive methods. Identifying the influences on discontinuation and switching across temporary methods versus switching to a permanent method, with particular attention to condom use/disuse in light of the HIV/AIDS pandemic, could help targeting of reproductive health services.