Motivational Factors in IUD Termination: Data from the Second Taiwan IUD Follow-Up Survey

In order to determine whether or not they were still using the IUD or their reasons for discontinuation if discontinuation had occurred, a sample of 4648 women who had accepted an IUD between March 1965-June 1966 were interviewed between December 1966-February 1977. The results are very similar to those obtained from an earlier survey and from other surveys taken in Taiwan. They showed: 1) the median duration of use is about 20 months, 2) about 1/3 of all terminations are because of the device itself (pregnancy or expulsion) and 2/3 are because of removal, and 3) the rates of removal do not stabilize and level off at about 12 months but continue to rise. The latter is an unexpected result; the expectation had been that most of the physical side effects of the IUD would subside after 6-12 months of use. It needs to be emphasized that IUD termination is not simply a matter of medical and physiological factors related to the IUD itself. Motivational factors also seem to be extremely important. An assessment of the motivational factors was made by exploring gross cumulative termination rates according to reason for using family planning (limitation vs. spacing), reason for removal (medical vs. nonmedical), and comparison of number of living children with number of chidren desired. In every case motivational factors are associated with continuation rate: 1) women who accept family planning to terminate childbearing have lower rates of removal for nonmedical reasons than women who accept family planning for spacing, 2) women who have more children than they want have lower rates of termination than women who have the desired number, and 3) women who have the desired number have lower termination rates than women who have fewer children than they want.