Correlates of IUD Termination in a Mass Family Planning Program

A sample of 2000 women, which was a probability sample of all 71,016 acceptors of IUDs in Taiwan between January 1964 and March 1965, was used in a follow-up study in 1965 to analyze correlates of various kinds of IUD terminations and contraceptive methods used after termination of use of the IUD. An additional 173 women interviewed in a provincial-wide KAP survey conducted simultaneously were also included. As far as possible, data from Taiwan as a whole were compared to those of Taichung. Data were analyzed using an adaptation of life-table methods. 2 types of rates were used; net rates which allowed for the possibility of competing risks in termination (pregnancy, expulsion, and removal) and gross cumulative rates which assumed that only 1 risk was operative. Termination rates were significantly greater in Taiwan as a whole than in Taichung with removal as the major cause, which emphasizes the necessity for better quality service and supporting follow-up visits. It was also presumed that variations in rates were related to acceptors' social characteristics. The womens' ages and parities were strongly related to type of termination, and those with at least 1 induced abortion had significantly lower termination rates. Women with higher levels of education had slightly higher removal and termination rates. Women whose last birth before insertion was less than 6 months before had low pregnancy termination rates, and women with long intervals since last birth had low expulsion and removal rates probably because they were older women with several children. At the time of the follow-up interview, 79% were using contraception either with the IUD or another method. The type of termination was an important determinant: 28% of those experiencing expulsion, 32% who had had the device removed, and 36% of those who had become pregnant were using contraception or had been sterilized. Induced abortion was quite common among those terminating pregnancies after first insertion. For all the women protection from additional pregnancy increased sharply with age or parity largely because of the higher retention rate for such women. 30% of the younger and low-parity women were unprotected compared to only 15% of the older and high-parity women. The greater practice by younger women of using the IUD to space births is a possible explanation of this difference. While the period studied was too short to yield significa nt results regarding fertility in Taiwan, the results suggest lower fertility for the future